| NPI | 1629117767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL V RYAN Partner 208-870-6308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2011-10-27 |