| NPI | 1679771190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOANNE H MAYHEW Owner 360-866-4445 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: WA DP00001622) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2020-08-22 |