Individual
MR. CHARLES RANDOLPH FISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
18124 114TH ST E, BONNEY LAKE, WA 98391-5168
(253) 229-5819
Mailing address
18124 114TH ST E, BONNEY LAKE, WA 98391-5168
(253) 229-5819
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00017977
WA
Other
Enumeration date
01/17/2008
Last updated
11/18/2010
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