| NPI | 1609409523 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRIE LYNNE KLOTZ Owner/Operator 503-206-9472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 246ZA2600X Specialist/Technologist, Other, Art, Medical |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2020-02-19 |