Individual
JUSTIN KIMBALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12408 SE FULLER RD, MILWAUKIE, OR 97222-1245
(503) 206-9631
Mailing address
12408 SE FULLER RD, MILWAUKIE, OR 97222-1245
(503) 206-9631
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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