| NPI | 1013141241 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DERRICK MOTEN Interim Business Servics Manager 503-988-2966 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2024-05-18 |