| NPI | 1770963274 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORY M SARTIN Clinic Director 208-426-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: ID NP-1093A) |
| Additional Taxonomies | 208VP0000X Pain Medicine Pain Medicine (Licence: ID NP-1093A) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2015-10-19 |