| NPI | 1588038616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARMEN HERNANDEZ RADFORD Fnp 208-757-1854 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: ID NP-1660A) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2015-12-01 |