NPI | 1285942631 |
---|---|
Entity Type | Organization |
Authorized Contact | ROBERT THEODORE LUNDBLAD Owner 503-779-8645 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR 1688) |
Enumeration Date | 2010-09-20 |
Last Update Date | 2010-09-20 |