| NPI | 1316246234 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRY GOMEZ Office Manager 253-779-5858 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MD00024441) |
| Enumeration Date | 2011-03-17 |
| Last Update Date | 2011-04-25 |