| NPI | 1639438955 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON E. STOGSDILL Clinician 253-970-0779 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA LH 60270904) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: WA CO 60180142) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2012-05-07 |