| NPI | 1134492986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA JACOBY Owner 360-573-3223 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA MA00016071) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2012-02-09 |