| NPI | 1740528884 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE PELT Clinic Administrator 360-538-0135 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60328816) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2013-01-24 |