| NPI | 1841681707 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MAYENO Member 425-255-9310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WA MD 00023599) |
| Enumeration Date | 2015-02-13 |
| Last Update Date | 2015-12-30 |