| NPI | 1770700072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY S NAGEL Office Manager 360-675-5555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QR1300X Clinic/Center, Rural Health |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2017-09-27 |