| NPI | 1205283413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RAYMOND KNUTSON L.M.P 360-975-0412 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: WA MA60316991) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-17 |