Facts
- Status
- A
- Type
- Organization
- Enumeration date
- 2008-08-19
- Last updated
- 2008-08-19
Specialties
Licenses
- License WA
- PT00010070
Location
- Practice location
- 208 CORRIN AVE. S.W.
- City
- ORTING WA
- Postal code
- 98360
- Phone
- 253-227-9747
Organization contact
- Name
- BRADLEY HARVIE
- Title
- President
- Phone
- 3608720401
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.