| NPI | 1992839906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA J ELDER Billing Manger 360-895-1521 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: WA MD00024942) |
| Enumeration Date | 2007-03-14 |
| Last Update Date | 2010-07-20 |