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1790751600
GEOFFREY WAYNE CLARK
PORTLAND, OR
NPI
1790751600
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2255A2300X Specialist/Technologist Athletic Trainer
(Licence: OR AT-AT-908663)
Enumeration Date
2006-02-28
Last Update Date
2007-07-08
Business Address
MR. GEOFFREY WAYNE CLARK ATC
7325 SW CHILDS RD
PORTLAND, OR 97224-7713
Phone number: 503-797-9812
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Mailing Address
MR. GEOFFREY WAYNE CLARK ATC
7325 SW CHILDS RD
PORTLAND, OR 97224-7713
Phone number: 503-797-9812
Copy
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