Lake Wilderness Medical Clinic LLC

NPI #1669647152 in Maple Valley, Washington

Provider Information

NPI Number
1669647152
Entity Type
Organization
Organization Name
Lake Wilderness Medical Clinic LLC
Primary Specialty
Clinic/Center - Medical Specialty
Enumeration Date
Apr 25, 2008
Last Updated
Apr 25, 2008

Practice Location

Address
26907 MAPLE VALLEY BLACK DIAMOND RD SE
ZIP Code
98038-8314
Phone
(425) 432-9611

Authorized Official

Name
DR. CHESTER EDMOND JANGALA JR., MD
Title
PHYSICIAN
Phone
(425) 432-9611

Specialties & Taxonomy Codes

Specialty
Clinic/Center - Medical SpecialtyMedical Specialty

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