| NPI | 1639561889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER PAULSON President 208-607-3738 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR 201050195NP) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2026-01-13 |