| NPI | 1134509904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD WAYNE ANDERSON Assistant Secreatry For Enrollment 425-358-9786 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA DI60174557) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2025-05-06 |