Individual
MS. TAMI LARAE GIBSON X
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
107 W NACHES AVE, SELAH, WA 98942-1323
(509) 945-9818
Mailing address
107 W NACHES AVE, SELAH, WA 98942-1323
(509) 945-9818
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
MA00018268
WA
Other
Enumeration date
04/26/2007
Last updated
07/08/2007
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