| NPI | 1144703885 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICKI M PETHES Credentialing Supervisor 425-277-1311 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-09-10 |
| Last Update Date | 2018-09-20 |