| NPI | 1003349127 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACI ANN PANTUSO Nd And Owner 360-527-5232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA NT60316767) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2017-04-05 |