| NPI | 1801036017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YVONNE MARIE ITO Director 360-403-7526 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60013935) |
| Enumeration Date | 2009-02-27 |
| Last Update Date | 2009-02-27 |