| NPI | 1780398586 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE RUE Office Manager 208-733-3181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-01-06 |
| Last Update Date | 2024-05-06 |