| NPI | 1508271792 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GWENDOLYN A LUCAS Owner 509-202-6596 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WA AP60203603) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2014-11-03 |