| NPI | 1205052198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNICE M CORDOVA President 208-365-3455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health (Licence: ID PA 281) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2020-08-22 |