| NPI | 1508106311 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM VINCENT Billing 541-516-4087 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: OR 98-R-03) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2013-02-15 |