| NPI | 1831194265 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDITH JEAN NIELSEN Clinic Manager 509-925-3151 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA 2520916959) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2020-08-22 |