Organization
AVALON CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT J. KENEVAN M.D. (MEDICAL DIRECTOR)
(253) 582-8486
Entity
Organization
Contact information
Practice address
6103 MOUNT TACOMA DR SW, LAKEWOOD, WA 98499-2727
(253) 582-8486
(253) 582-2644
Mailing address
6103 MOUNT TACOMA DR SW, LAKEWOOD, WA 98499-2727
(253) 582-8486
(253) 582-2644
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MD00015225
WA
Other
Enumeration date
05/03/2007
Last updated
03/23/2012
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