| NPI | 1902353907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDELL CHARLES HEIDINGER Owner 541-507-1948 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OR md18680) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2018-04-18 |