| NPI | 1841077807 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES TATE WOODWARD Physician/Owner 406-309-4780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2023-09-13 |
| Last Update Date | 2024-10-04 |