| NPI | 1003047721 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA J FOORD Provider/Owner 208-263-1345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID RPA-156) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2012-04-26 |