| NPI | 1871648352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIRSTEN GRUNZKE Practice Administrator 208-364-3000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: ID M7481) |
| Additional Taxonomies | 208600000X Surgery (Licence: ID M8489) |
| 208600000X Surgery (Licence: ID M7975) | |
| 208600000X Surgery (Licence: ID M8195) | |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2010-06-29 |