| NPI | 1396111357 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ANN FISHER-ROTHERY Owner 208-629-9351 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: ID CHIA-1292) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2015-08-13 |