| NPI | 1760739973 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSE JOHNSON Office Manager 208-282-4421 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID NP-1199A) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2012-08-07 |