| NPI | 1174520191 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BLAKE V FAUSETT Owner/Medical Director 541-434-0922 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: OR 071545) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2025-06-05 |