| NPI | 1720247877 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI WAGGONER Office Manager 360-253-6883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WA CH00002774) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA PT00006628) |
| Enumeration Date | 2008-06-04 |
| Last Update Date | 2008-07-28 |