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 |