| NPI | 1124792502 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER RENEE CICILIAN Doctor, Owner 971-353-7990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2021-08-09 |
| Last Update Date | 2024-10-28 |