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 |