| NPI | 1629492814 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN KEITH CROWNOVER Vice President 208-695-6355 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M11819) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-1080) |
| Enumeration Date | 2014-02-10 |
| Last Update Date | 2014-02-10 |