| NPI | 1184915829 |
|---|---|
| Doing Business As | PPS PROVIDENCE FAMILY MEDICINE INDIAN TRAIL |
| Entity Type | Organization |
| Authorized Contact | MICHAEL J MALLORY Credentialing Specialist 425-525-6798 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2011-04-28 |