| NPI | 1104896422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MARIE BOTAI Practice Administrator 208-765-4807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: ID 13C0001058) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2025-06-26 |