| NPI | 1124410139 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE KURSCHEIDT President 208-884-2885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ID chia-1588) |
| Enumeration Date | 2015-02-27 |
| Last Update Date | 2015-02-27 |