Individual
BRENT SISSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRT
Contact information
Practice address
1519 3RD ST SE, SUITE 103, PUYALLUP, WA 98372-3742
(253) 841-8939
Mailing address
1519 3RD ST SE, SUITE 101, PUYALLUP, WA 98372-3742
(253) 841-8939
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
RT00003985
WA
Other
Enumeration date
10/15/2008
Last updated
10/15/2008
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