| NPI | 1528599685 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY NEAL ZOLA Medical Director 360-742-3562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: WA MD60017650) |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2017-03-21 |