| NPI | 1407366545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SYLVIA A OWEN Physician/Owner 406-314-6336 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: MT 10806) |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2017-12-12 |