| NPI | 1467818054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAURIE A PACHECO Owner 406-459-1416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain (Licence: MT COFSLNLIC4452) |
| Enumeration Date | 2016-01-12 |
| Last Update Date | 2016-01-12 |