| NPI | 1962895961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ARIEL MASTRICH Owner 503-880-2570 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: WA NT60374417) |
| Additional Taxonomies | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2015-03-15 |
| Last Update Date | 2015-03-15 |