| NPI | 1891247706 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ISAIAH GARY ALLISON Idmt 360-589-6025 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1710I1003X Military Health Care Provider, Independent Duty Medical Technicians |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2016-10-26 |