| NPI | 1760840755 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARSHA M FULTON Director Of Operations 360-998-3232 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 603514766) |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2022-07-21 |