| NPI | 1972871838 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONHNNY BROUSSARD Health Service Adminitrator 253-779-6052 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251K00000X Public Health or Welfare (Licence: WA AP30005661) |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2011-12-07 |