| NPI | 1477377927 |
|---|---|
| Other Name | SOUTH FORK FOREST CAMP |
| Entity Type | Organization |
| Authorized Contact | ROB CORY NUTT Chief Pharmacy Officer 503-986-6967 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2400X Clinic/Center, Prison Health |
| Enumeration Date | 2024-11-12 |
| Last Update Date | 2024-11-12 |