| NPI | 1245665322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIFFANY COTHERN Billing Specialist 253-507-8367 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA BL13-00627) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |