| NPI | 1164539912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK R HALLER Medical Director 208-783-1267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M8355) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2013-02-14 |