| NPI | 1255728887 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUG HAGENSEN Director Of Operations 360-255-5049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA MD60450667) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |