Wolf Pack LLC

NPI #1992323216 in Ammon, Idaho

Provider Information

NPI Number: 1992323216
Entity Type: Organization
Organization Name: Wolf Pack LLC
Primary Specialty: Clinic/Center
Enumeration Date: Jul 13, 2020
Last Updated: Jul 13, 2020

Practice Location

Address: 939 S 25TH E STE 115
City: Ammon
State: Idaho
ZIP Code: 83406-5736
Phone: (208) 523-1209

Authorized Official

Name: SHAWN TOLMAN
Title: CEO
Phone: (208) 313-1089

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center	261Q00000X	Primary

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