Puyallup Tribe of Indians is located in Pierce County, Washington. The family medicine residency has Osteopathic Recognition strives to be integrative and teach residents strategies for working with Native American Traditional Medicine approaches and prepare residents to care for underserved Native communities. Residents at PTHA train primarily at two core sites (MultiCare Tacoma General Hospital and the Takopid Clinic) and rural training at Indian Health Services Sites across WWAMI regions. Obstetric training in the first year occurs at both Tacoma General and Auburn, WA. Opportunities for rural electives are available as well.