| NPI | 1780722819 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MARK PETTIT Owner 360-676-2749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA 601949981) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-11-30 |