| NPI | 1558719450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HENRY HARDY Managing Member Medical Director 971-804-1906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine Addiction Medicine |
| Enumeration Date | 2016-06-01 |
| Last Update Date | 2016-06-01 |