| NPI | 1598982324 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID L FAIRBROOK Owner 360-491-4460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine Geriatric Medicine |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-08-22 |