| NPI | 1245989292 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER A CARLSON Owner, Practitioner 509-581-3550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2022-05-25 |