| NPI | 1922257823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL REESE FLANDRO Owner/President 208-232-6675 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: ID ODP-702) |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2009-07-21 |