| NPI | 1619320785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWNA GAMACHE Office Manager 509-965-4114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA DE60334963) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |