| NPI | 1295420651 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA QUALL Np 208-957-7808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-12-05 |