| NPI | 1700920782 |
|---|---|
| Doing Business As | PRO SPORTS CLUB |
| Entity Type | Organization |
| Authorized Contact | DEBBIE BECKER Sr Director Of Accounting 425-869-4746 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: WA 600541508) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA 600541508) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2017-08-07 |