Graduated: 2023
NPI: 1023909959
Practice Locations (3)
4600 TOUCHTON RD E, SUITE 100150
Jacksonville, FL 322461542
2632 BEARCO LOOP, SUITE 88
LA Grande, OR 978505335
1807 COVE AVE
LA GRANDE, OR 978503516
Source: CMS National Downloadable File, September 2026.