Individual
DIANE SERVANTEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2202 W C ST, TORRINGTON, WY 82240-1807
(307) 532-0362
Mailing address
2202 W C ST, TORRINGTON, WY 82240-1807
(307) 532-0362
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
01/21/2016
Last updated
01/21/2016
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