| NPI | 1659047298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY SCOTT SIDELL Registered Agent/Executor 253-693-0022 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Enumeration Date | 2021-08-23 |
| Last Update Date | 2021-08-23 |