| NPI | 1083985428 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILTON LOUIS BLETTEL Member Manager 503-894-9464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR MD15147) |
| Enumeration Date | 2012-01-17 |
| Last Update Date | 2012-05-14 |