| NPI | 1669727400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE FEDEWA Owner 208-991-0352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: ID chia1466) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2012-07-18 |