| NPI | 1407237175 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN SCOTT SOSZKA Member/Manager 503-388-6715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: OR 1333) |
| Enumeration Date | 2015-06-17 |
| Last Update Date | 2022-03-24 |