| NPI | 1588107999 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JANICE L SUSSMAN Executive Director 360-452-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 601149379) |
| Enumeration Date | 2016-12-02 |
| Last Update Date | 2016-12-02 |