Organization
CONCORDIA WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM MAGRAW LMT (SOLE MEMBER)
(503) 449-7631
Entity
Organization
Contact information
Practice address
3014 NE KILLINGSWORTH ST, PORTLAND, OR 97211-6814
(503) 449-7631
Mailing address
3014 NE KILLINGSWORTH ST, PORTLAND, OR 97211-6814
(503) 449-7631
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
19492
OR
261Q00000X
Clinic/Center
4194
CA
Other
Enumeration date
11/01/2017
Last updated
10/03/2020
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