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 Clinic/Center |
Enumeration Date | 2014-09-17 |
Last Update Date | 2014-10-29 |