| NPI | 1710234190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER ALICE MAYFIELD Member, Manager 509-413-2105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 16849) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2018-11-28 |