| NPI | 1104291657 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS SCOTT FELLOWS Owner 208-251-9925 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID CHIA-1615) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2020-06-18 |