| NPI | 1528385283 |
|---|---|
| Doing Business As | PPS PROV FAMILY MED LIDGERWOOD |
| Entity Type | Organization |
| Authorized Contact | ANSELMO NUNEZ CFO 509-474-6616 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2010-04-21 |
| Last Update Date | 2011-02-28 |