| NPI | 1174282172 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI L MCQUEEN Contract & Recruitment Manager 541-967-3866 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty |
| Enumeration Date | 2021-12-17 |
| Last Update Date | 2021-12-17 |