NPI
LastName
FirstName
MidName
Organization
Mailing Address
City
State
Zip
1780737106
BLACK
JOSEPH
L
 
3181 SW SAM JACKSON PARK RD
PORTLAND
OR
972393011
1629086491
OTTO
BETTRICIA
A
 
3181 SW SAM JACKSON PARK RD
PORTLAND
OR
97239
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