| NPI | 1285159251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARIE BOOM Owner 503-310-2622 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: OR 7615) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2022-07-21 |