| NPI | 1275073926 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LIANE TALLEY HOPPS Owner, Operator 360-209-4199 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: WA OT 00003587) |
| Enumeration Date | 2017-02-28 |
| Last Update Date | 2017-02-28 |