| NPI | 1033345012 |
|---|---|
| Doing Business As | PROVIDENCE INTEGRATIVE MEDICINE WEST |
| Entity Type | Organization |
| Authorized Contact | DENNIS NOONAN Chief Finance Officer 503-216-4657 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2009-06-04 |