NPI | 1952923765 |
---|---|
Entity Type | Organization |
Authorized Contact | CORBIN BUNNAGE Provider/Owner 208-542-9111 |
Organization Subpart ? | No |
Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
261QX0100X Clinic/Center, Occupational Medicine | |
Enumeration Date | 2020-05-14 |
Last Update Date | 2024-07-25 |