Individual
ALICIA LEANDRA GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
5450 CUDA LN UNIT 102, TUMWATER, WA 98512-6942
(360) 349-3979
Mailing address
5450-102 CUDA LANE SW, TUMWATER, WA 98512
(360) 349-3979
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60109727
WA
Other
Enumeration date
02/05/2010
Last updated
02/08/2010
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