| NPI | 1558606111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDDIE HANSEN Owner 360-933-1405 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 225100000X Physical Therapist |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2012-12-06 |