| NPI | 1528015229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA FARLEY Technical COO Rdinator 425-917-6282 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2008-01-15 |