| NPI | 1508271198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RACHEL PULVER Owner 503-929-7722 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR 201050014NP) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: OR 201050014NP) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2016-03-07 |