| NPI | 1902220411 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE S HARRIS Owner 208-454-0567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: ID M9670) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2014-02-13 |