| NPI | 1528025293 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY CHARLES WELLER Pediatrician 360-457-8578 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 601481297) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2015-11-05 |