| NPI | 1235239203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MORI J MONTAGNE Owner/Provider 503-245-1459 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR 092000262N5) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: OR 092000262N5) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2020-08-22 |