| NPI | 1831610641 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOT SULLIVAN Owner 503-841-7593 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OK 20157) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2017-06-30 |