| NPI | 1588846091 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIVIAN BLANCO Member 360-352-7779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 025209 MD00036490) |
| Enumeration Date | 2007-11-27 |
| Last Update Date | 2007-11-27 |