| NPI | 1134641640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE R MOLES Counselor 406-529-3629 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: MT 16133) |
| Additional Taxonomies | 251S00000X (Licence: MT 1252) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2022-07-21 |