| NPI | 1740238054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLEN L BERRY Owner 360-683-4181 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA MD00018876) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2020-08-22 |