| NPI | 1285886770 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANA LISA CHARLES Owener/A RN P 360-259-8300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA AP30006938) |
| Enumeration Date | 2008-10-16 |
| Last Update Date | 2010-08-10 |