| NPI | 1962916437 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JILL ANN DUDIK BROSS Owner 509-766-9450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 208D00000X General Practice |
| 261QR1300X Clinic/Center, Rural Health | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2017-11-20 |