| NPI | 1932530284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELODIE WILSON Manager 360-736-0928 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: WA 603173594) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2014-06-30 |