| NPI | 1457990509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JA-ANGEL DEWALT Billing Lead 360-377-3776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2020-01-06 |