| NPI | 1336214204 |
|---|---|
| Former Legal Business Name | AMBULANCE SPORTS MEDICINE |
| Entity Type | Organization |
| Authorized Contact | BRENT M FAURE Owner 208-241-2487 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3416L0300X Ambulance, Land Transport (Licence: ID 4623) |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2020-08-22 |