| NPI | 1730134206 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH TELLEZ Dha Financial Manager 360-475-4459 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1100X Clinic/Center Military/U.S. Coast Guard Outpatient |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2025-06-13 |