| NPI | 1093009847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK MCCLAIN SACCOMAN President 208-324-0222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID CHIA-650) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2011-06-08 |