| NPI | 1083995740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTIE JO COPPEDGE Owner 425-670-2102 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LW00007408) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2011-10-27 |