| NPI | 1659552057 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ANTON FACKENTHALL Physician/Owner 509-525-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA OP00000703) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2013-01-03 |