| NPI | 1801115019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS RYAN MCBRIDE President 503-488-5485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 603007695) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: OR 731371) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2011-05-16 |