| NPI | 1235362724 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA PATE Cd PT 360-435-3985 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA CO60105693) |
| Enumeration Date | 2009-08-31 |
| Last Update Date | 2009-08-31 |