| NPI | 1235556846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI MCCOY Provider Enrollment Specialist 360-729-1411 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: AK 5790) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2014-03-20 |