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1316512049
WISE MOUNTAIN MEDICINE LLC
BEND, OR
NPI
1316512049
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Entity Type
Organization
Authorized Contact
CARLTON ANDREW KELCH
Co Owner
970-406-1019
Organization Subpart ?
No
Primary Taxonomy
261Q00000X Clinic/Center
Enumeration Date
2021-05-25
Last Update Date
2021-05-25
Business Address
WISE MOUNTAIN MEDICINE LLC
335 NE REVERE AVE
BEND, OR 97701-4059
Phone number: 541-238-7285
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Mailing Address
WISE MOUNTAIN MEDICINE LLC
2150 NW HILL ST APT 3
BEND, OR 97703-1373
Phone number: 970-406-1019
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