| NPI | 1760529374 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL DAVIS Clinic Manager 360-566-9355 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 208000000X Pediatrics | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2014-07-23 |