Individual
TINA BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
210 SPARKS DR, KELSO, WA 98626-1818
(360) 431-8275
Mailing address
PO BOX 796, KELSO, WA 98626-0069
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
—
—
Other
Enumeration date
12/06/2011
Last updated
12/06/2011
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