| NPI | 1598000960 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN I BRUBAKER Clinic Coordinator 541-342-8255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2012-12-11 |
| Last Update Date | 2019-06-28 |