Individual
MISS LISA M CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
4308 N 26TH ST, TACOMA, WA 98407-5211
(253) 820-1303
Mailing address
PO BOX 7011, TACOMA, WA 98417-0011
(253) 820-1303
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00024438
WA
Other
Enumeration date
07/15/2007
Last updated
03/15/2010
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