| NPI | 1407280704 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE JORDAN Office Manager 509-822-7719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: WA PA60125661) |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2013-08-23 |