| NPI | 1679635023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD DAVIS President 503-248-1114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OR 4512) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2020-08-22 |