| NPI | 1922735273 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE LYN FOX Credentialing Supervisor 253-681-6603 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-08-05 |