| NPI | 1609872761 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ANN DUDIK BROSS Owner/Physician 509-766-9450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WA MD00026434) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WA MD0025968) |
| 208000000X Pediatrics (Licence: WA MD60174015) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2012-12-24 |