| NPI | 1043559081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY L FAVERO Owner/President 509-962-2273 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2013-02-12 |
| Last Update Date | 2013-03-15 |