| NPI | 1942685052 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA REIDUN GALVEZ Owner 425-381-3866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA MA 00003466) |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |