| NPI | 1417971847 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLLINTON MALLARI Owner 208-342-4700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID 13-C0001056) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |