| NPI | 1700148251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ELGIN KOEN Cheif Officer 541-752-0776 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center Primary Care (Licence: OR 3838) |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2012-06-11 |