JEDIDIAH ALLEN PETERSEN

POLSON, MT
NPI1366870206
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: ID  PA-1110)
Enumeration Date2013-10-30
Last Update Date2015-12-08
Business Address
-- JEDIDIAH ALLEN PETERSEN PA
6 13TH AVE E
POLSON, MT 59860-5315
Phone number: 406-883-5680
Mailing Address
-- JEDIDIAH ALLEN PETERSEN PA
PO BOX 262
LIBERTY LAKE, WA 99019-0262
Phone number: 208-232-7862
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