| NPI | 1871044917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ERIC JORGENSON Owner 541-490-5719 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center (Licence: OR 3047) |
| Additional Taxonomies | 261QH0100X Clinic/Center, Health Services |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2023-01-09 |