| NPI | 1558585455 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL E. ESTESS President 208-345-2630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ID M-3173) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-08-22 |