| NPI | 1235195447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RAY SKINNER Administrator 503-907-1907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 07-1567) |
| Additional Taxonomies | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 394819) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-05-04 |