| NPI | 1285024497 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA L WARD Owner 208-312-9740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: ID NP-1514A) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2015-03-23 |