| NPI | 1063617967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC DANIEL THOMAS Physician 360-923-1111 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WA op00001758) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2008-06-30 |