| NPI | 1508820879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA POE Credentialing Specialist 509-935-6001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental (Licence: WA J600317870) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2023-07-18 |