| NPI | 1366560971 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RON WADE PORTER Owner 208-522-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: ID M7271) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2020-08-22 |