Organization
PLACE OF FOOD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATIE WYATT (OWNER/CEO)
(208) 490-2778
Entity
Organization
Contact information
Practice address
1131 COLE ST, KIMBERLY, ID 83341-5138
(208) 490-2778
Mailing address
1131 COLE ST, KIMBERLY, ID 83341-5138
(208) 490-2778
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
05/24/2018
Last updated
05/24/2018
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