| NPI | 1417019829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LO FONDREN Manager 541-683-0878 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR MD13787) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |