| NPI | 1750731311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODY ELLEFSEN Physician/Owner 509-724-0198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA OP00002282) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-06-15 |