| NPI | 1619140506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY MICHEAL DOMBY Owner/President 503-543-3195 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR 27 2310) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |