| NPI | 1952583536 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE LEE PIRANIO Doctor 360-459-3333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA OD00003048) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2015-10-27 |