NPI | 1023520814 |
---|---|
Entity Type | Organization |
Authorized Contact | KIM MAGRAW Sole Member 503-449-7631 |
Organization Subpart ? | No |
Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR 19492) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: CA 4194) |
Enumeration Date | 2017-11-01 |
Last Update Date | 2020-10-03 |