| NPI | 1275876849 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE K BANCROFT Billing Manager 509-926-7106 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery |
| Enumeration Date | 2013-04-02 |
| Last Update Date | 2013-04-02 |