Individual
MR. ANDREI VLADIMIROVICH MITSOUROV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
53387 W CROCKETT RD, MILTON FREEWATER, OR 97862-7941
(509) 540-1665
Mailing address
53387 W CROCKETT RD, MILTON FREEWATER, OR 97862-7941
(509) 540-1665
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA 60230518
WA
Other
Enumeration date
12/12/2011
Last updated
12/12/2011
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