| NPI | 1740260892 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY L LARSON Office Manager 208-798-8968 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00015580) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2011-01-07 |