| NPI | 1730451527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOROTHY JENSEN Business Mgr 360-658-0256 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WA DN000021) |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2012-02-08 |