| NPI | 1821407081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOLLY KOCZARSKI Registered Dietitian 360-580-5423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1103X Clinic/Center, Military Ambulatory Procedure Visits Operational (Transportable) (Licence: WA DI60083621) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |