| NPI | 1922105154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN ARDELL MOE Provider Enrollment Specialist 206-263-8807 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP0905X Clinic/Center Public Health, State or Local |
| Additional Taxonomies | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2021-04-21 |