| NPI | 1689869836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBBY WILCOX Manager 208-232-2146 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: ID M9470) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2018-07-05 |