TANNA SUSAN WILLIS

BOISE, ID
NPI1033551015
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy225700000X Massage Therapist
(Licence: ID  MAS-732)
Additional Taxonomies261QS1000X Clinic/Center, Student Health
(Licence: ID  820290701)
Enumeration Date2013-07-19
Last Update Date2013-07-19
Business Address
-- TANNA SUSAN WILLIS LCMT
1529 BELMONT ST
BOISE, ID 83725-0001
Phone number: 208-426-1459
Mailing Address
-- TANNA SUSAN WILLIS LCMT
1910 UNIVERSITY DR
BOISE, ID 83725-1351
Phone number: