| NPI | 1821503418 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PATE Practice Manager 541-340-9607 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR PA150149) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |