| NPI | 1134236433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS D MCKIM Owner 208-367-6901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: ID M7009) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2020-08-22 |