| NPI | 1023151156 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE MARIE BUNNAGE Billing Manager 208-542-9111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID 2082807848) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2020-08-22 |