| NPI | 1043635543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG COOPER ELLSWORTH President 509-924-1580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA DE60390327) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2026-02-03 |