| NPI | 1518272087 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE S RUE Office Manager 208-733-3181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID M7113) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2013-11-05 |