| NPI | 1720521719 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEE SCOTT STEVENS Owner Operator 208-785-0270 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ID CHIA-1502) |
| Enumeration Date | 2016-11-23 |
| Last Update Date | 2019-11-04 |