Organization
ALTER IMAGE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EVA B KOZLOWSKI LE, CPE (OWNER)
(503) 267-3166
Entity
Organization
Contact information
Practice address
2340 SE GLADSTONE ST, PORTLAND, OR 97202-2962
(503) 267-3166
Mailing address
6340 SE CLATSOP ST, PORTLAND, OR 97206-0716
(503) 267-3166
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
06/18/2020
Last updated
06/18/2020
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