Individual
CAROL L LIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP-CR
Contact information
Practice address
1503 NE 78TH ST, VANCOUVER, WA 98665-9666
(360) 903-5758
Mailing address
3870 ADDY ST, WASHOUGAL, WA 98671-2705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16389
WA
Other
Enumeration date
09/06/2007
Last updated
09/06/2007
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