| NPI | 1598508053 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHERRIE JOSEPH Executive Director 208-233-6245 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 208D00000X General Practice |
| Enumeration Date | 2024-06-13 |
| Last Update Date | 2024-06-13 |