| NPI | 1063844728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA LEE ELY Owner Manager 208-589-1615 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare |
| Additional Taxonomies | 251X00000X |
| Enumeration Date | 2013-08-05 |
| Last Update Date | 2013-08-05 |