| NPI | 1770877888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY E JOSEPH Owner 208-233-2100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: ID M-6309) |
| Enumeration Date | 2011-06-06 |
| Last Update Date | 2021-09-07 |