| NPI | 1508176991 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W SHEAFOR Owner 360-647-0557 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA PO 60134920) |
| Enumeration Date | 2010-10-19 |
| Last Update Date | 2014-10-19 |