| NPI | 1104016138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY H INGLIS Office Manager 360-262-3966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR1300X Clinic/Center, Rural Health |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD00039760) |
| 363AM0700X Physician Assistant, Medical (Licence: WA PA10004588) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2012-04-26 |