Provider First Line Business Practice Location Address:
121 N. LAST CHANCE GULCH, LOGAN HEALTH CHILDREN'S SPECI
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-603-4900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007