| NPI | 1700113313 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN E HENDERSON Direrctor 541-646-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR 200950142NP) |
| Enumeration Date | 2009-11-03 |
| Last Update Date | 2009-11-03 |