| NPI | 1265654958 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT J. KENEVAN Medical Director 253-582-8486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA MD00015225) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2012-03-23 |