Organization
KEYSAR CENTER OF MASSAGE FOR THE MEDICALLY FRAGILE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KACI J JONES LMP (OWNER)
(206) 724-5393
Entity
Organization
Contact information
Practice address
500 W MAIN ST, SUITE D, CENTRALIA, WA 98531-4252
(360) 623-1214
(360) 623-1215
Mailing address
500 W MAIN ST, SUITE D, CENTRALIA, WA 98531-4252
(360) 623-1214
(360) 623-1215
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60156485
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA60156485
INTRA ORAL
WA
Enumeration date
11/28/2011
Last updated
11/28/2011
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