| NPI | 1073711081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES COFFEE CEO 360-636-3892 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2022-05-31 |