| NPI | 1134394489 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA LYNN NIELSON Owner Manager 503-318-6799 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR 14141) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2008-04-28 |