| NPI | 1316118177 |
|---|---|
| Doing Business As | NONE |
| Entity Type | Organization |
| Authorized Contact | BARBARA JEAN THOMPSON Director 360-856-6300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2022-07-21 |