Individual
CHARLIE N JIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
25012 104TH AVE SE, STE C, KENT, WA 98030-2821
(253) 856-3477
(253) 856-3478
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909
(630) 296-2223
(630) 759-9510
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60743843
WA
Other
Enumeration date
04/03/2017
Last updated
04/03/2017
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