| NPI | 1609117282 |
|---|---|
| Doing Business As | PROVIDENCE MEDICAL GROUP LACTATION CLINIC |
| Entity Type | Organization |
| Authorized Contact | DONALD W ANDERSON Dir Reimb Reg Strat/Asst Sec Enroll 425-525-5392 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2013-03-07 |
| Last Update Date | 2021-01-15 |