| NPI | 1790872109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY C WALKER Owner 208-227-1200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204C00000X Neuromusculoskeletal Medicine, Sports Medicine (Licence: ID E65389) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2016-03-10 |