| NPI | 1366859159 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIK CRAIG MILDES President 206-999-4534 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WA PY60086116) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2014-07-14 |