| NPI | 1841400850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID B RUSS Owner 503-754-6136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty (Licence: OR 3117) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2020-08-22 |