NPI | 1548260177 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT L LYCKSELL Owner 360-679-3161 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center |
Additional Taxonomies | 207Q00000X Family Medicine |
207R00000X Internal Medicine | |
Enumeration Date | 2005-07-26 |
Last Update Date | 2009-12-04 |