| NPI | 1467981233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LAUREN SUE GRAYBILL Owner 208-568-1983 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 261QR0400X Clinic/Center, Rehabilitation |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2022-07-25 |