| NPI | 1699167239 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN BELLACOV President 503-351-8427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: OR 3857) |
| Enumeration Date | 2015-02-19 |
| Last Update Date | 2015-02-19 |