| NPI | 1114978848 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARLA PEARSON Credentialing Specialist 360-242-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical |
| Additional Taxonomies | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: WA 601 061 994) |
| 261QS0132X Clinic/Center Ophthalmologic Surgery (Licence: WA 601 061 994) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2022-07-18 |