NPI age
17 years
Enumerated 2008-06-02
Across 40 active clinic/center providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 05 (ID) | 808259000 | |
| 05 (ID) | 808257100 | |
| 05 (ID) | 808028200 |
Single-site organization. Only one practice location on file.
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