Individual
WARREN BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9887 ADAMS ST, JOINT BASE LEWIS-MCCORD, WA 98433
(915) 791-2882
Mailing address
9887 ADAMS ST, JOINT BASE LEWIS MCCHORD, WA 98433-1401
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
302016
TX
Other
Enumeration date
08/11/2015
Last updated
08/11/2015
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