| NPI | 1124026745 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GALE V STOVERN Business Manager 503-612-8452 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 393476) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-08-22 |