| NPI | 1154015592 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WILLIAMS Manager, Provider Data & Enrollment 253-459-8009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-06-07 |