| NPI | 1235712621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY EDWARD LINER CEO 509-495-1810 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine Adult Medicine |
| Additional Taxonomies | 207QA0000X Family Medicine Adolescent Medicine |
| 207QG0300X Family Medicine Geriatric Medicine | |
| 2084P0800X Psychiatry & Neurology Psychiatry | |
| Enumeration Date | 2021-05-03 |
| Last Update Date | 2023-08-10 |