| NPI | 1265879548 |
|---|---|
| Doing Business As | TED WENZEL |
| Entity Type | Organization |
| Authorized Contact | TED WENZEL Owner 208-376-0480 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2013-05-28 |