Individual
MS. ANTONINA KOROSTELEVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
319 WASHINGTON AVE S, KENT, WA 98032-5767
(253) 850-9780
(253) 850-6445
Mailing address
317 5TH AVE N, ALGONA, WA 98001-4421
(253) 632-0772
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA60035115
WA
Other
Enumeration date
04/03/2009
Last updated
04/03/2009
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