| NPI | 1750725677 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLYSA TAYLOR Lmp 253-861-6691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: WA 60314731) |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2013-04-22 |