| NPI | 1205196649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW R PETERSON Owner 360-752-0518 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA MD00040970) |
| Enumeration Date | 2012-05-18 |
| Last Update Date | 2012-05-18 |