| NPI | 1326404468 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER PELTZ Office Manager 360-692-6202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2016-01-05 |
| Last Update Date | 2022-08-04 |