| NPI | 1245260454 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHERYL R MAHLBERG Office/Business Manager 360-426-4142 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA MD00032175) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2008-05-27 |