| NPI | 1730280744 |
|---|---|
| Former Legal Business Name | D. ANTHONY & R. RANDEL HENNEBERG, PTR'S |
| Entity Type | Organization |
| Authorized Contact | ANDREW ANTHONY HENNEBERG Owner/Md 208-765-4888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ID M-9485) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2020-05-14 |