| NPI | 1902166739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAN M PEDRO Sole Owner Propriator 406-850-2279 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: MT 935) |
| Enumeration Date | 2012-05-27 |
| Last Update Date | 2012-05-27 |