| NPI | 1487942058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER LEE MOORE Owner 406-541-7763 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MT 1219) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2012-08-02 |