| NPI | 1386189983 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CY ROBERT FISHER Managing Physician/Owner/Operator 360-698-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA NT 60508818) |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2017-01-05 |