| NPI | 1144918434 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ZION DANIEL DIXON Owner/Otr/L 208-819-4327 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2023-04-26 |
| Last Update Date | 2024-04-22 |