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4TH STREET MEDICAL CARE, PLLC

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Company Details

Legal Name: 4TH STREET MEDICAL CARE, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Administratively Dissolved
Formation/ Registration Date: September 23rd 2003
Date of Dissolution: February 3rd 2018
Expiration date: 30 Sep 2017
UBI Number: 602 329 907

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Registered Agent Information

Name Role Address
DR SANTOSA HO Registered Agent 1602 4TH ST, MARYSVILLE, WA, 98270-0000, UNITED STATES

Key Officers & Management

Name Role
SANTOSA HO Governing Person

National Provider Identifier

NPI Number:
1659559409

Authorized Person:

Name:
DR. SANTOSA HO
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
261QP2300X - Primary Care Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
3606591712
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