| NPI | 1831213404 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICK SAMUEL BIALOCK Director 360-698-7267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA 18047501) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2008-06-30 |