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510 Sw 3rd Ave Ste 210 Portland OR 97204-2507 | |
(503) 224-5010 | |
Not Available |
Full Name | |
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Speciality | Clinic/center |
Location | 510 Sw 3rd Ave Ste 210, Portland, Oregon |
Authorized Official Name and Position | Lisa Jewell (OWNER) |
Authorized Official Contact | 9202162958 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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510 Sw 3rd Ave Ste 210 Portland OR 97204-2507 Ph: (503) 224-5010 | 510 Sw 3rd Ave Ste 210 Portland OR 97204-2507 Ph: (503) 224-5010 |
NPI Number | 1306352836 |
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Provider Enumeration Date | 12/20/2017 |
Last Update Date | 12/20/2017 |
Identifier | Type | State | Issuer |
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1306352836 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | 5655 (Oregon) | Primary |
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