| NPI | 1619144607 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDICE AUMAN Credentialing Specialist 360-242-3008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA 601061994) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| 261QS0132X Clinic/Center, Ophthalmologic Surgery (Licence: WA 601061994) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2022-07-18 |