| NPI | 1356794481 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARRELL K TEW President 509-853-3622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: WA DE00006691) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |