| NPI | 1821155953 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ARDELL MOE Practice Management Administrator 206-263-8807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: WA DI 00000539) |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2022-10-13 |