| NPI | 1811343924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARIE LEILANI ANDERSON Provider 530-321-7971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: CA 95005662) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: WA AP60710618) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2017-04-19 |