| NPI | 1346407244 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDALL HUGH LEAVITT Owner 503-816-2184 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: OR 273413) |
| Enumeration Date | 2008-05-19 |
| Last Update Date | 2008-05-19 |