Individual
EUGENE STATELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICENSED MASSAGE THE
Contact information
Practice address
2801 GREAT NORTHERN LOOP, MISSOULA, MT 59808-1745
(406) 370-4474
Mailing address
2798 RICH CT, MISSOULA, MT 59804-7125
(406) 370-4474
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
590
MT
Other
Enumeration date
07/03/2013
Last updated
08/28/2013
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