| NPI | 1821559154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM H HALL Physician 360-370-2873 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0001X |
| Additional Taxonomies | 332900000X Non-Pharmacy Dispensing Site |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-10-08 |