| NPI | 1720489396 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOSEPH BERRIA President 208-740-4518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care (Licence: OR PA00913) |
| Enumeration Date | 2014-09-14 |
| Last Update Date | 2023-08-16 |