| NPI | 1710324686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WASEEM MAKHOUL Director 503-208-9144 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR MD150278) |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty (Licence: WA MD60113845) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2013-05-31 |