| NPI | 1043523681 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANA SUZANNE LEACH Owner/Operator 360-339-2942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA MA 60096769) |
| Enumeration Date | 2010-07-26 |
| Last Update Date | 2010-07-26 |