| NPI | 1164619557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY D LOCKNANE Owner/Doctor 425-368-4242 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: WA MD00036179) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: WA MD00036179) |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2007-09-28 |