| NPI | 1538605035 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CARNINE HECKER Owner 208-699-9870 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA MD60237462) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-02-06 |