| NPI | 1063784700 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACOB LEROY BLAKE CEO/Physician 503-894-0365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP3300X Clinic/Center Pain (Licence: WA MD60071790) |
| Enumeration Date | 2012-01-26 |
| Last Update Date | 2012-03-19 |