| NPI | 1023568466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMBER LEE CLARK Owner 541-678-4212 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR 10629) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2016-10-10 |