| NPI | 1255788592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARRED MCDANIEL Owner 406-577-2346 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: MT 27907) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: MT 27907) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2017-02-23 |