| NPI | 1952509929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN ALFRED WALCK Owner/President 360-535-4729 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA 35530) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2007-07-10 |