| NPI | 1235385543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GEORGE MICHAEL GOTT CEO 208-794-4774 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID CHIA490) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2009-12-18 |