| NPI | 1912046210 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHERINE ELIZABETH DURBORAW Owner 208-529-8232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2015-12-29 |