| NPI | 1134472947 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDIE POND Billing Manager 360-479-0508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WA 1977) |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2012-10-17 |