| NPI | 1609068352 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUZANNE M FLETCHER Practice Administrator 360-479-4370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA MD00010979) |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2007-10-11 |