| NPI | 1467816199 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBYANN BERNICE ALDRIDGE Office Manager 208-878-6413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2023-03-16 |