| NPI | 1538504774 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM L DEPRATI President 360-582-2690 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2013-05-01 |
| Last Update Date | 2013-05-01 |