| NPI | 1205072451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REYNALDO GONZALEZ Owner 509-930-9111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA LW00008771) |
| Enumeration Date | 2008-12-17 |
| Last Update Date | 2008-12-17 |