| NPI | 1245549724 |
|---|---|
| Doing Business As | PROVIDENCE INTEGRATIVE MEDICINE BRIDGEPORT |
| Entity Type | Organization |
| Authorized Contact | DENNIS NOONAN Administration 503-216-4657 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2011-11-02 |