| NPI | 1487811394 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHIRLEY PROVOZNIK Administrator 360-338-0181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: WA OT00004122) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2019-04-25 |