| NPI | 1417118787 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAVONNE R. MILLS Owner/President 208-236-1600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M4489) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2008-06-19 |