| NPI | 1891817011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA NARANJO Practice Manager 406-587-8478 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0131X (Licence: MT 129) |
| Additional Taxonomies | 261QP1100X Clinic/Center, Podiatric |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-05-30 |