| NPI | 1760726293 |
|---|---|
| Doing Business As | PROVIDENCE ORAL HEAD AND NECK CANCER CLINIC NORTH |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Enumeration Date | 2012-11-21 |
| Last Update Date | 2013-09-25 |