Individual
FIGHTER FOR GOD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 E COLLEGE WAY, MOUNT VERNON, WA 98273-5612
(360) 848-8437
Mailing address
1601 E COLLEGE WAY, MOUNT VERNON, WA 98273-5612
(360) 848-8437
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/05/2017
Last updated
12/05/2017
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