Individual
TERESEA JOANN CARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
207 ALLEN ST, KELSO, WA 98626-3403
(360) 575-9311
Mailing address
207 ALLEN ST, KELSO, WA 98626-3403
(360) 575-9311
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00013581
WA
Other
Enumeration date
03/02/2012
Last updated
11/22/2016
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