| NPI | 1164578340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY J POTTER Account Manager 509-891-1291 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: WA MD00013210) |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2008-01-05 |