| NPI | 1497949705 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE A SHELTON Administrator 208-287-6558 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2014-06-05 |