| NPI | 1255659066 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA ANDRE'A ANDERSON Owner 360-457-7374 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA AC 00002207) |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2010-05-04 |