| NPI | 1023789351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDY ALLEN WILDER Board Member 503-730-6577 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2021-09-27 |
| Last Update Date | 2021-09-27 |