LAKE WILDERNESS MEDICAL CLINIC LLC

MAPLE VALLEY, WA
NPI1982879045
Entity TypeOrganization
Authorized ContactCHESTER E JANGALA
Physician
425-432-9611
Organization Subpart ?No
Primary Taxonomy302F00000X Exclusive Provider Organization
(Licence: WA  MD00023662)
Enumeration Date2008-04-29
Last Update Date2008-04-29
Business Address
LAKE WILDERNESS MEDICAL CLINIC LLC
26907 MAPLE VALLEY BLACK DIAMOND RD SE
MAPLE VALLEY, WA 98038-8314
Phone number: 425-432-9611
Mailing Address
LAKE WILDERNESS MEDICAL CLINIC LLC
PO BOX 1142
RAVENSDALE, WA 98051-1142
Phone number: 425-432-9611