Individual
MS. DIANNE INDIA FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1415B HUME ST S, TACOMA, WA 98444-2646
(253) 355-2094
Mailing address
1415B HUME ST S, TACOMA, WA 98444-2646
(253) 355-2094
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60176613
WA
Other
Enumeration date
07/19/2010
Last updated
03/19/2015
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