| NPI | 1265855118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERI PETERSON Reimbursement Specialist 208-954-5594 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M-12269) |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2014-01-29 |