| NPI | 1902048879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK B RENCHER Physician 208-523-0888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID M4486) |
| Enumeration Date | 2009-03-24 |
| Last Update Date | 2009-03-24 |