Individual
JACQUELINE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
(208) 377-9515
(208) 377-9517
Mailing address
3630 E LOUISE DR, MERIDIAN, ID 83642-7975
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/14/2008
Last updated
08/14/2008
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