| NPI | 1538205935 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNY WALKER Owner 208-323-6601 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: ID 4DEVCON127) |
| Additional Taxonomies | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: ID 3DEVCON128) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2008-03-03 |