| NPI | 1619351582 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK DAVID MEAD Owner 208-448-4222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID CHIA 1645) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-07-10 |