| NPI | 1457552770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLEIGH PATRON Manager 253-472-4473 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 28116) |
| Additional Taxonomies | 207QS0010X Family Medicine Sports Medicine (Licence: WA 28116) |
| 208D00000X General Practice (Licence: WA 15856) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2024-10-10 |