| NPI | 1285801480 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL G. BLACKBURN Owner 253-841-4243 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA MD00019306) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2019-07-23 |