| 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 |