Individual
MR. KEVIN R LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.P.
Contact information
Practice address
4902 TACOMA MALL BLVD, TACOMA, WA 98409-7149
(253) 473-0300
(253) 473-0305
Mailing address
3217 EASTLAKE AVE E APT 304, SEATTLE, WA 98102-7124
(253) 224-0103
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00016150
WA
Other
Enumeration date
10/12/2006
Last updated
05/15/2008
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