| NPI | 1871919639 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE ELDRIDGE Clinic Administrator 503-362-6304 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: OR MD11557) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2014-03-17 |