| NPI | 1659405140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GENE K HODGES Owner 208-522-3301 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: ID M4937) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2016-11-07 |