| NPI | 1497766240 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARY V JACKSON President 208-233-5864 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: ID M5647) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2020-08-22 |