| NPI | 1053034652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE L FOX Credentialing Supervisor 253-681-6603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-02-25 |