| NPI | 1245990126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TANNER C KIMBLE Owner/ CEO 208-410-0569 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant |
| Enumeration Date | 2021-12-20 |
| Last Update Date | 2021-12-20 |