| NPI | 1629218870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS COZZOCREA Director 503-977-9975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: OR 5688) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services (Licence: WA 602807738) |
| Enumeration Date | 2009-03-01 |
| Last Update Date | 2016-02-17 |