| 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 |