| NPI | 1619399235 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTI WALLACE Nurse Practitioner 541-337-4000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR 201050185NP) |
| Enumeration Date | 2014-01-16 |
| Last Update Date | 2014-01-16 |