| NPI | 1124234703 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | TIMOTHY ROY PETERS Owner 503-873-6987 |
| Organization Subpart ? | No |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: OR md17287) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-02-12 |