| NPI | 1316659899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVY GWOST Co Owner 360-391-9311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0200X Clinic/Center Radiology |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2022-12-16 |
| Last Update Date | 2024-06-12 |