| NPI | 1053729434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICKI N HULET Owner/President 208-520-2242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation (Licence: ID SLP-1461) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-07-29 |