| NPI | 1982773370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN FRANCES HYMAN Sole Proprietor 360-697-7100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA PT00006826) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WA MA00005937) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-08-22 |