| NPI | 1982015822 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH CHARLES ROMNEY Owner 208-736-3362 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: ID M-11134) |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2014-05-14 |