| NPI | 1770620742 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEVIN LARSEN CEO 208-340-1840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: FL 390) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-08-15 |