NPI | 1114507928 |
---|---|
Entity Type | Organization |
Authorized Contact | TERI ROUSE Agent 208-691-4569 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
Enumeration Date | 2021-04-14 |
Last Update Date | 2021-04-14 |