| NPI | 1073971933 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENAE GRIMES Receptionist 253-274-0484 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WA 578077922) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2016-03-10 |