Organization
FSC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LLOYD WISNIEWSKI MD (CO-OWNER)
(307) 670-3500
Entity
Organization
Contact information
Practice address
1503 CRESSETT ST, GILLETTE, WY 82716-3339
(307) 670-3500
Mailing address
PO BOX 962, GILLETTE, WY 82717-0962
(307) 670-3500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
10312
WY
Other
Enumeration date
05/04/2011
Last updated
05/04/2011
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