| NPI | 1508083627 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARLA ANN TELIN Chief Operating Officer 509-926-7106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: WA 602489086) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2020-08-22 |