| NPI | 1770608424 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN J KINSLEY Senior Medical Officer 541-756-9237 |
| Organization Subpart ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: OH 35057309) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2020-08-22 |