| NPI | 1134616477 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFF TUNICK Managing Member 360-464-1492 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60790564) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2018-04-20 |