Individual
KENTON IRVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 W FAGIN ST, ENNIS, MT 59729-8923
(406) 539-7133
Mailing address
200 W FAGIN ST, PO BOX 160, ENNIS, MT 59729-8923
(406) 539-7133
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
12601
MT
Other
Enumeration date
02/18/2014
Last updated
02/18/2014
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