| NPI | 1912385220 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY O'BRIEN MCFADDEN Owner 509-965-5750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA CH60105748) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2023-05-19 |