MATTHEW WADE BLACK

GRANGEVILLE, ID
NPI1891415063
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant Medical
(Licence: ID  PA-2620)
Enumeration Date2022-08-29
Last Update Date2023-10-25
Business Address
MATTHEW WADE BLACK PA
607 W MAIN ST
GRANGEVILLE, ID 83530-1345
Phone number: 208-983-1700
Mailing Address
MATTHEW WADE BLACK PA
607 W MAIN ST
GRANGEVILLE, ID 83530-1345
Phone number: 208-983-1700
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