| NPI | 1053503854 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERESA JANE TWEED Owner 509-899-5228 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WA 602379332) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |