| NPI | 1952687386 |
|---|---|
| Doing Business As | PROVIDENCE FAMILY MEDICINE MANITO CLINIC |
| Entity Type | Organization |
| Authorized Contact | MICHAEL MALLORY Cred. Specialist 425-525-6798 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2011-10-31 |