| NPI | 1699175158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANAE DAVISON Authorized Official 208-539-9923 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology (Licence: CA 154319) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2017-11-02 |