Individual
TYRA S GARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
224 KAMEHAMEHA AVE # 201, HILO, HI 96720-2860
(215) 485-6788
Mailing address
5811 WOODCREST AVE, PHILADELPHIA, PA 19131-2214
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/20/2010
Last updated
01/25/2022
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