| NPI | 1639370810 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALLACE COLEMAN BAKER CEO 208-524-6633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: ID M6919) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2020-08-22 |