| NPI | 1093984668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JAMES CORLL Business Owner 503-582-9200 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR 27 3234) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2023-07-10 |