| NPI | 1609206309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER DAVIS Office Manager 208-478-2172 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2013-11-15 |