| NPI | 1093708422 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROGER K LARSON Authorized Official 206-244-5477 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD00007073) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2011-09-19 |