| NPI | 1336519891 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL GILBERT Practice Manager 208-232-7760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: ID M-12503) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2015-09-28 |