| NPI | 1093104572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DORY ROSE BRONGER Owner/Manager 206-779-9460 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WA LW00009554) |
| Enumeration Date | 2015-01-21 |
| Last Update Date | 2015-01-21 |