| NPI | 1356738694 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KYLE BERGQUIST Owner 360-362-0551 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty (Licence: WA MD60359416) |
| Enumeration Date | 2015-04-24 |
| Last Update Date | 2016-07-12 |