| NPI | 1437178399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADEN M STAUTS Owner/Partner 208-514-4740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology (Licence: ID 4-D-2095) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2020-08-22 |