| NPI | 1275707630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RALPH D HECKARD Manager 208-201-0795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID M4388) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2008-04-16 |