| NPI | 1053643783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVIN LARSEN CEO 208-340-1840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: CA 23135) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2024-05-30 |