| NPI | 1033433230 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TYLER KELIIHELEUA Manager/Provider 503-246-2995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR 1635) |
| Enumeration Date | 2010-03-17 |
| Last Update Date | 2010-03-17 |