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Individual

ROMAN ANTIOQUIA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
6808 220TH ST SW, SUITE 203, MOUNTLAKE TERRACE, WA 98043-2187
(425) 776-1056
Mailing address
6808 220TH ST SW, SUITE 203, MOUNTLAKE TERRACE, WA 98043-2187
(425) 776-1056

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60384227
WA

Other

Enumeration date
09/10/2014
Last updated
09/10/2014
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