| NPI | 1184824617 |
|---|---|
| Other Name | NONE |
| Entity Type | Organization |
| Authorized Contact | MICHAEL DAVID KENNER Doctor/Owner 208-453-1062 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2007-07-23 |