| NPI | 1841853553 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALAN FERES KARAM Owner 503-884-1476 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-04-18 |