| NPI | 1144297003 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN G CARROUGHER Medical Director 253-272-8664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0800X (Licence: WA FX00056070) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA ASF.FS.60099979) |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-01-14 |