The Golden Room LLC

NPI #1205172913 in Portland, Oregon

Provider Information

NPI Number: 1205172913
Entity Type: Organization
Organization Name: The Golden Room LLC
Primary Specialty: Specialist
Enumeration Date: Dec 27, 2012
Last Updated: Dec 27, 2012

Practice Location

Address: 636 SE 49TH AVE
City: Portland
State: Oregon
ZIP Code: 97215-1728
Phone: (971) 506-4560

Authorized Official

Name: MAURI MCKITRICK
Title: OWNER/LMT
Phone: (971) 506-4560

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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