| NPI | 1790153138 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERICHA CLARE Physician/Owner 360-882-4642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WA NT60545534) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: WA AC60545576) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2017-03-20 |