| NPI | 1245566348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY B GREEN President 360-377-4717 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: WA 35113) |
| Additional Taxonomies | 208C00000X Colon & Rectal Surgery (Licence: WA 35113) |
| Enumeration Date | 2009-10-23 |
| Last Update Date | 2009-10-23 |