| NPI | 1811441652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HILAREY BOLY Propritor 503-998-4281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center Health Service (Licence: OR AC01068) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-08-10 |