| NPI | 1134504145 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA FUHRMAN Lmp Owner 509-331-6308 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA MA 00011423) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2015-07-21 |