| NPI | 1649544693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALINDA G GREENWOOD Administrative Manager 360-748-4393 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 21155800) |
| Enumeration Date | 2012-03-07 |
| Last Update Date | 2012-03-07 |