| NPI | 1790083509 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE JEAN SOPER Office Manager/Owner 541-347-4321 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: OR D4777) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2011-03-02 |