| NPI | 1518022615 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYCE E POTTER Owner 503-224-1371 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 071440) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2020-08-22 |