| NPI | 1871867432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANNIELLE BOUCHER Billing Specialist 509-420-0423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: WA LH 60151067) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2012-02-29 |