| NPI | 1073319174 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE BRAZIER Administrative Services Director 360-475-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| Enumeration Date | 2025-02-20 |
| Last Update Date | 2025-02-20 |