Individual
JUSTIN SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3106 84TH ST S, LAKEWOOD, WA 98499-8990
(253) 588-7180
Mailing address
3106 84TH ST S, LAKEWOOD, WA 98499-8990
(253) 588-7180
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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