Individual
LONZALL TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1212 SW CLAY ST APT 409, PORTLAND, OR 97201-7822
(361) 771-4454
Mailing address
1212 SW CLAY ST APT 409, PORTLAND, OR 97201-7822
(361) 771-4454
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
08/13/2019
Last updated
08/13/2019
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