| NPI | 1528488996 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SATYA AMBROSE Owner 503-658-7715 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: OR 100484898) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2014-04-23 |