| NPI | 1679103485 |
|---|---|
| Doing Business As | AUTUMN RIDGE MEDICAL GROUP |
| Entity Type | Organization |
| Authorized Contact | JASON FLETCHER President 208-376-7298 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-01-21 |