| NPI | 1619241346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WAYNE BRADFORD President 360-459-7713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA MD0019897) |
| Enumeration Date | 2012-02-27 |
| Last Update Date | 2012-02-27 |