| NPI | 1154356624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER R. MILLIER Owner/Partner 208-336-8250 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: N/A for group) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2011-02-25 |