| NPI | 1841550126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE FEDEWA Owner 208-991-0352 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: ID CHIA1466) |
| Enumeration Date | 2012-05-21 |
| Last Update Date | 2012-08-27 |