| NPI | 1730250259 |
|---|---|
| Doing Business As | EASTSIDE BRANCH |
| Entity Type | Organization |
| Authorized Contact | SEAN POTTER Billing Manager 206-323-0930 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2023-10-04 |