| NPI | 1477912889 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARYANN POTTER Credentialing Specialist 541-246-9106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2016-02-12 |
| Last Update Date | 2016-02-12 |