| NPI | 1164699021 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARVIN DAVID SEPPALA Medical Officer 503-644-8700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: OR 22576) |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2008-05-09 |