Organization
PEACH WILLOW LLC
Active
Other names
Peach Willow Spa
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN GOODE (GENERAL MANAGER)
(360) 773-5110
Entity
Organization
Contact information
Practice address
9015 E MILL PLAIN BLVD, VANCOUVER, WA 98664-2536
(360) 773-5110
Mailing address
9015 E MILL PLAIN BLVD, VANCOUVER, WA 98664-2536
(360) 773-5110
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
89329
WA
Other
Enumeration date
02/03/2018
Last updated
06/11/2019
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