| NPI | 1467537951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARK PETTIT Owner Doctor 360-671-9197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA 602558844) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-11-19 |