| NPI | 1508103193 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY ALAN ANDERSON Owner 360-402-4840 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: UT 8536046-1202) |
| Enumeration Date | 2013-01-15 |
| Last Update Date | 2018-01-23 |