| NPI | 1992759815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REINIER VAN COEVORDEN Md 425-557-4227 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA MD00031289) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2007-12-06 |