Individual
TIA MAUMI BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
200 SW 41ST ST STE 100, RENTON, WA 98057-4917
(425) 251-5715
(425) 251-0703
Mailing address
200 SW 41ST ST STE 100, RENTON, WA 98057-4917
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60243032
WA
Other
Enumeration date
11/23/2011
Last updated
11/23/2011
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