| NPI | 1114912102 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LOCKWOOD Authorized Official 208-342-7169 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID 1870273) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2026-04-18 |