| NPI | 1023385721 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP DOCTORS BUILDING |
| Entity Type | Organization |
| Authorized Contact | KATLYN L LEE Credentialing & Onboarding Speciali 509-474-2072 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2011-11-23 |