Individual
MR. RANDAL D. GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
507 N PINE ST, SUITE E, ELLENSBURG, WA 98926-5024
(509) 925-1525
(509) 925-1526
Mailing address
314 1/2 N PINE ST, #2, ELLENSBURG, WA 98926-3373
(509) 929-1162
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00023402
WA
Other
Enumeration date
05/28/2008
Last updated
05/28/2008
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