| NPI | 1194160515 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JACOBSEN Business Manager 503-908-1590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR MD20480) |
| Enumeration Date | 2013-04-30 |
| Last Update Date | 2014-04-26 |