| NPI | 1083660021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANDREW BERGLOFF President 208-888-7889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: ID D-3409) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-08-22 |