| NPI | 1205230489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXIMO DIMAUNAHAN AZUCENA Provider 425-322-5328 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WA 751038) |
| Enumeration Date | 2014-10-16 |
| Last Update Date | 2014-10-16 |