| NPI | 1356854830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY RAE CAPPADONA Registered Dietitian 541-955-2582 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2017-11-07 |