Individual
MS. TARA MARIE GRAVISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EXPRESSIVE ARTS
Contact information
Practice address
4661 35TH ST, SAN DIEGO, CA 92116-3537
(619) 962-9853
Mailing address
4661 35TH ST, SAN DIEGO, CA 92116-3537
(619) 962-9853
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/13/2014
Last updated
12/13/2014
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