| NPI | 1740479476 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D WIGOD M.D. 208-377-9515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: ID M8189) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2013-09-16 |