| NPI | 1497205652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN HALVORSON Chief Compliance Officer 509-444-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2025-01-03 |