| NPI | 1790960094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD JAMES CONLIN President 208-232-3131 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ID HA-384) |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2008-01-04 |