| NPI | 1558512277 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CURTIS CARPENTER Owner 208-346-7045 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ID d-4169) |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2008-10-01 |