| NPI | 1265665921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBEKAH W INGALLS Owner 206-789-0456 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 2027) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: WA 11627) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2013-11-13 |