| NPI | 1639493216 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA L LANGAN Provider Enrollment Specialist 206-548-3114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 600138418) |
| Enumeration Date | 2010-03-25 |
| Last Update Date | 2011-05-09 |