| NPI | 1962896027 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONNY RYAN FISHER CEO 208-238-0088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2024-08-15 |