| NPI | 1902387285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL SUHY STILLER Member Manager 208-920-0285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: ID 54178) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-11-09 |