Individual
MS. LACEY GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1359 NE 35TH AVE, PORTLAND, OR 97232
(503) 799-9405
Mailing address
1359 NE 35TH AVE, PORTLAND, OR 97232-1941
(503) 799-9405
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
22287
OR
Other
Enumeration date
09/01/2016
Last updated
09/01/2016
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