| NPI | 1558828236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VONDA WINFREE Co Owner Administrator 208-359-4840 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2019-02-28 |
| Last Update Date | 2024-05-20 |