| NPI | 1588066906 |
|---|---|
| Doing Business As | PROVIDENCE INTEGRATIVE MEDICINE WEST |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2014-10-29 |