| NPI | 1700446085 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW S WHITACRE Medical Director / Md 360-640-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2023-07-26 |