| NPI | 1841737699 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY JONES Credentialing Specialist 503-413-4318 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: WA 60709743) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2017-01-31 |