| NPI | 1639516180 |
|---|---|
| Doing Business As | IDAHO WEIGHT LOSS |
| Entity Type | Organization |
| Authorized Contact | WILBUR ALLEN RADER President 208-343-3652 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RB0002X Internal Medicine, Bariatric Medicine (Licence: ID M7878) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2013-05-23 |