| NPI | 1194778498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID LEE RUSSELL Owner 360-376-4949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-05-28 |