| NPI | 1851328447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAVON KELLER Billing Supervisor 360-353-9431 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 2083P0901X Preventive Medicine Public Health & General Preventive Medicine |
| 261Q00000X Clinic/Center | |
| 261QH0100X Clinic/Center Health Service | |
| 261QR0405X Clinic/Center Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2024-10-31 |