Individual
AMBER LIDDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12033 SE 256TH ST, KENT, WA 98030-6503
(253) 373-7000
Mailing address
13915 SE 201ST ST, KENT, WA 98042-3067
(253) 630-0240
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
OC00000966
WA
Other
Enumeration date
09/03/2014
Last updated
09/03/2014
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