| NPI | 1003352410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANN GANNON Practice Manager 509-315-4415 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208200000X Plastic Surgery (Licence: WA MD00036729) |
| Enumeration Date | 2017-01-09 |
| Last Update Date | 2017-01-09 |