| NPI | 1649680190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WADE DEAN BURBANK Owner/Doctor 360-567-1739 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA CH00033654) |
| Enumeration Date | 2014-05-06 |
| Last Update Date | 2014-08-20 |