| NPI | 1386818912 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELISSA M DEFOREST Member 206-465-9550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: WA NT00001646) |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2008-04-15 |