| NPI | 1700235900 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY ANDERSON Authorized Official/Billing Admin 541-646-5122 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: CT 002925) |
| Enumeration Date | 2016-06-08 |
| Last Update Date | 2016-06-08 |