| NPI | 1063935286 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAMERON CHESNUT President / Owner 208-640-1488 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2024-02-28 |