| NPI | 1043690126 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN M PETTIT Owner 360-714-3400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA 603455361) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2015-09-15 |