| NPI | 1235418625 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA RUDESTAM Sole Proprietor 971-409-4049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR AC150554) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-08-16 |