| NPI | 1801393681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEEANN OWLETT Billing Manager 360-637-9263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: WA 604239064) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2018-08-17 |