| NPI | 1982026571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SCOTT HOWARD Member 208-631-6396 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: ID W104488) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |