| NPI | 1770062242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER LYNN KREIDLER-MOSS Chief Executive Officer 360-377-3776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2018-08-07 |
| Last Update Date | 2018-08-07 |