Organization
THE GOLDEN ROOM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MAURI MCKITRICK (OWNER/LMT)
(971) 506-4560
Entity
Organization
Contact information
Practice address
636 SE 49TH AVE, PORTLAND, OR 97215-1728
(971) 506-4560
Mailing address
4360 NE SIMPSON ST, PORTLAND, OR 97218-1444
(971) 506-4560
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
8161
OR
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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