| NPI | 1871672899 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENT WALLACE Owner 425-899-5510 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WA PA10000442) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-08-22 |