| NPI | 1063861805 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA LARSON Owner 206-451-0937 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LW60491393) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2016-06-10 |