| NPI | 1376729541 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STANLEY J CHESLOCK Owner, President 208-529-6430 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M3570) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2008-01-17 |