| NPI | 1164451142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANNIELLE MARIE HANCOCK Account Manager 360-631-5971 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health (Licence: WA AP30001255) |
| 261QP2300X Clinic/Center, Primary Care (Licence: WA AP30001255) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2023-08-18 |