| NPI | 1730494964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SARAH SANDERS Provider Enrollment Coordinator 509-416-8849 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LH60172419) |
| Enumeration Date | 2010-08-12 |
| Last Update Date | 2010-08-12 |