| NPI | 1518593904 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ARDELL MOE Provider Enrollment Specialist 206-263-8807 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-03-17 |
| Last Update Date | 2020-03-17 |