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Organization

THE WALLACE MEDICAL CONCERN

Active
Other names
Wallace
Organization subpart
No

Provider details

NPI number
Authorized official
LISA CLINE MPH (CEO)
(503) 489-1760
Entity
Organization

Contact information

Practice address
1165 N MAIN AVE, GRESHAM, OR 97030-5543
(503) 489-1760
(503) 489-1763
Mailing address
18633 SE STARK ST STE 401, PORTLAND, OR 97233-5468
(503) 489-1760
(503) 489-1763

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
124Q00000X
Dental Hygienist
207Q00000X
Family Medicine Physician
Primary

Other

Enumeration date
09/06/2024
Last updated
09/06/2024
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