Individual
TARA N PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.M.P.
Contact information
Practice address
530 S 336TH ST STE C, FEDERAL WAY, WA 98003-6383
(253) 391-7216
Mailing address
530 SOUTH 336TH STREET STE C, FEDERAL WAY, WA 98003
(253) 391-7216
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60101618
WA
Other
Enumeration date
04/22/2015
Last updated
04/22/2015
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