| NPI | 1497874903 |
|---|---|
| Former Legal Business Name | PUYALLUP CLINIC INC., PS |
| Entity Type | Organization |
| Authorized Contact | JERRY FRED DURIS President And CEO 253-845-6645 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 261Q00000X) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2019-07-31 |