| NPI | 1710168125 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARI RENEE MILLER Owner 206-244-3006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: WA 17080) |
| Additional Taxonomies | 174400000X Specialist (Licence: WA 17080) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2007-11-14 |