| NPI | 1164210332 |
|---|---|
| Former Legal Business Name | FAIRWOOD RESTAURANT |
| Entity Type | Organization |
| Authorized Contact | ROBERT L ALLEN Member 509-218-0413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2025-04-28 |
| Last Update Date | 2025-04-28 |