| NPI | 1205316569 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN C. CLARK Executive Director 360-330-9595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-08-16 |
| Last Update Date | 2018-08-16 |