| NPI | 1093068652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNA RILEY Owner 206-300-4089 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WA PA10004765) |
| Enumeration Date | 2012-10-19 |
| Last Update Date | 2012-12-14 |