| NPI | 1780037879 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD ZIEBART Manager 503-363-4636 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: UT 2016ALIIUT000744) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2016-07-13 |