| NPI | 1275818130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY KATHLEEN BERGER Biller 360-297-8805 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00024570) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA MD 00036316) |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |