| NPI | 1063611408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secretary For Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA H-159) |
| Enumeration Date | 2007-07-16 |
| Last Update Date | 2025-07-25 |