| NPI | 1801296447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOHN TILLEY Owner 503-974-6170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: OR 14698) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2014-09-02 |