| NPI | 1851610760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACIE LEE STEPHENSON Office Manager 208-782-0675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: ID LCSW261187) |
| Enumeration Date | 2010-05-18 |
| Last Update Date | 2010-05-18 |