MULTNOMAH COUNTY

NPI # 

Practice Address:

12710 Se Division St

Portland, OR, 97236-3134

Practice Phone:

503-988-3663

Practice Fax:

503-988-3015

License State:

OR

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Federally Qualified Health Center (FQHC)

Taxonomy Code:

261QF0400X