| NPI | 1073800934 |
|---|---|
| Doing Business As | MICHAEL MONTGOMERY |
| Entity Type | Organization |
| Authorized Contact | MICHAEL ISRAEL MONTGOMERY Owner 612-520-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: MN 2102) |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2011-06-29 |