Individual
MISS CRYSTALLENE CELESTIAL MEDLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1146 COMMERCE AVE, LONGVIEW, WA 98632-3025
(360) 577-6956
Mailing address
138 E STOCK RD, KELSO, WA 98626-9763
(360) 430-1484
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60278590
WA
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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