| NPI | 1972821254 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON DARRYL SOHM Owner 208-322-6260 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID CHIA-1398) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2010-05-11 |