| NPI | 1386954956 |
|---|---|
| Doing Business As | CLINIC DERMATOLOGY |
| Entity Type | Organization |
| Authorized Contact | BRADLEY GAIL JELLERICHS Owner 253-251-2688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: WA 603049127) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2023-12-12 |