| NPI | 1265512818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA MARIE SIMON Owner President 208-939-3505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VG0400X Obstetrics & Gynecology, Gynecology |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-08-22 |