| NPI | 1104987734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY HILL Practice Administrator 360-491-1112 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: WA GAB20096) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-08-22 |