| NPI | 1336145846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARYN L CLARK Clinic Administrator 360-856-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA 600-088-066) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2020-08-22 |