| NPI | 1457894339 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN KENNETH MCRAE Dr. Of Nurse Practioner 208-229-8739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID 54169) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2023-07-07 |