| NPI | 1912130006 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SEAN R WHITE Owner / President 360-532-1950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA MD 60082203) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2009-08-24 |