Graduated: 2021
NPI: 1730844838
Practice Locations (3)
LEGACY CLINICS LLC
2870 SW CEDAR HILLS BLVD
BEAVERTON, OR 970051354
5036469222
ICCO LLC
1755 SW BAKER ST
MCMINNVILLE, OR 971289112
9719004522
LEGACY CLINICS LLC
3425 SE 192ND AVE, SUITE 106
VANCOUVER, WA 986831440
3602052960
Source: CMS National Downloadable File, September 2026.