| NPI | 1053540898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MARIA MADARIETA TARRANT Financial Coordinator 208-938-8228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2009-07-14 |