| NPI | 1417977208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL KEVIN GANNON Provider 360-733-7670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: WA MD0022602) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2013-05-23 |