| NPI | 1982037727 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANENE RAYNE Owner/Partner 208-377-3299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: ID M-7882) |
| Enumeration Date | 2013-08-15 |
| Last Update Date | 2018-06-13 |