| NPI | 1184442303 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLI K GAMETTE Owner 208-473-1301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |