| NPI | 1093726796 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN L PETERSON CEO 406-541-3937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MT 11789) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2021-04-20 |