| NPI | 1124273685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA BOWMAN Delegated Official 208-559-7417 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: CA A63302) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2018-06-16 |