| NPI | 1922037530 |
|---|---|
| Doing Business As | FIFTH AVENUE CLINIC |
| Entity Type | Organization |
| Authorized Contact | WARREN ALAN STEVENSON CEO 208-324-1122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2008-05-08 |