| NPI | 1760551410 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRILYNN NICKLIN GRISWOLD Billing Manager 360-434-3009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA 002495) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |