| NPI | 1205241106 |
|---|---|
| Other Name | ROBERT LACK |
| Entity Type | Organization |
| Authorized Contact | ROBERT GLENN LACK Administrator 509-735-7410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 03060500) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2014-06-30 |