| NPI | 1548433790 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS D MCKIM Owning Physician 208-367-6901 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID M7009) |
| Enumeration Date | 2008-04-09 |
| Last Update Date | 2008-04-11 |