| NPI | 1720362775 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY VERNALEE MARSON Office Manager 208-365-3455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID NP-701A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: ID N-33941) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2011-10-07 |