| NPI | 1215248836 |
|---|---|
| Other Name | PROVIDENCE UROLOGY CENTRALIA |
| Entity Type | Organization |
| Authorized Contact | NICOLE QUINN Payor Credentialing Manager 425-525-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2010-12-22 |