| NPI | 1881429918 |
|---|---|
| Doing Business As | WALLACE |
| Entity Type | Organization |
| Authorized Contact | LISA CLINE CEO 503-489-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 104100000X Social Worker |
| 124Q00000X Dental Hygienist | |
| Enumeration Date | 2024-09-06 |
| Last Update Date | 2024-09-06 |