Organization
MOD SKIN AND BODY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POLLY TABARES (CEO)
(425) 406-8455
Entity
Organization
Contact information
Practice address
14130 JUANITA DR NE STE 110, KIRKLAND, WA 98034-0127
(425) 406-8455
Mailing address
14130 JUANITA DR NE STE 110, KIRKLAND, WA 98034-0127
(425) 406-8455
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/09/2013
Last updated
01/10/2014
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