| NPI | 1912270661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAWNI WEAVER Director 208-939-4456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: ID NP-784A) |
| Enumeration Date | 2012-02-10 |
| Last Update Date | 2012-04-30 |