| NPI | 1912376005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY PEXTON Medical Director 360-415-9110 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP3300X Clinic/Center, Pain |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| 332900000X Non-Pharmacy Dispensing Site (Licence: WA OP60339103) | |
| Enumeration Date | 2015-09-18 |
| Last Update Date | 2019-07-22 |