| NPI | 1003974460 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MOORE Administrator 360-813-6021 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WA 2085R0202X) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2015-04-14 |