| NPI | 1174907638 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIA EVELYN WILBER Owner/Manager 971-255-1708 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR 5143) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2015-07-15 |