| NPI | 1154561116 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH W IPPOLITO Medical Doctor/Owner 208-736-7620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ID M7008) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2012-08-29 |