| NPI | 1801450259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANENE E RAYNE Owner/Administrator 208-859-6262 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |