| NPI | 1750832259 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACEY LYN PRUSKY Officer 360-560-3801 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: HI 119306444801) |
| Enumeration Date | 2016-10-19 |
| Last Update Date | 2016-10-19 |