| NPI | 1932115391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA J PRECIADO Billing Supervisor 509-962-9841 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center Rural Health |
| Additional Taxonomies | 174400000X Specialist (Licence: WA H 140) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2021-08-03 |