| NPI | 1124468624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ILONA MAY LORD Member 253-476-3154 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WA 603004801) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2013-06-28 |