| NPI | 1821490335 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENIFER LEAH BARRY Director/Owner 208-344-8482 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: ID M-11233) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2016-01-26 |