| NPI | 1881077261 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN J BREWER Lmp 425-435-5838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: WA ma00018402) |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2015-07-03 |