| NPI | 1710925250 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARNOLD CANTU Clinic Administrator 208-528-7655 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2006-06-04 |
| Last Update Date | 2023-11-13 |