Individual
TABATHA BURRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
14410 PETROVISTSKY RD SE #109, RENTON, WA 98058
(425) 226-1856
Mailing address
17533 151ST AVENUE SE UNIT 8-9, RENTON, WA 98058
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60160181
WA
Other
Enumeration date
11/22/2010
Last updated
11/22/2010
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