| NPI | 1609023811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JARED L HANSON President 208-887-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID CHIA-1305) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |