| NPI | 1164813101 |
|---|---|
| Doing Business As | EVERGREEN WELLNESS STUDIOS |
| Entity Type | Organization |
| Authorized Contact | LAUREN MARIE DONBAR Owner 208-895-8595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ID CHIA 1555) |
| Enumeration Date | 2015-02-12 |
| Last Update Date | 2015-02-12 |