GRESHAM INTERNAL MEDICINE CLINIC

GRESHAM, OR
NPI1134204340
Entity TypeOrganization
Authorized ContactJOHN M CUSTIS
Owner/Partner
503-667-1015
Organization Subpart ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: OR  01794)
Enumeration Date2006-10-26
Last Update Date2008-12-11
Business Address
GRESHAM INTERNAL MEDICINE CLINIC
24900 SE STARK ST STE 109
GRESHAM, OR 97030-3381
Phone number: 503-667-1015
Mailing Address
GRESHAM INTERNAL MEDICINE CLINIC
PO BOX 23200
PORTLAND, OR 97281-3200
Phone number: 503-667-1015
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