Individual
CARLY LORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19045 STATE HIGHWAY 305 NE STE 190, POULSBO, WA 98370-7312
(360) 697-6100
Mailing address
19045 STATE HIGHWAY 305 NE STE 190, POULSBO, WA 98370-7312
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60263894
WA
Other
Enumeration date
01/29/2014
Last updated
01/29/2014
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