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1073292512
MATTHEW VAUGHN EDWARD PROVOST
SEATTLE, WA
NPI
1073292512
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101Y00000X Counselor
Enumeration Date
2023-07-12
Last Update Date
2023-07-12
Business Address
MATTHEW VAUGHN EDWARD PROVOST
1700 AIRPORT WAY S
SEATTLE, WA 98134-1618
Phone number: 206-206-4822
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Mailing Address
MATTHEW VAUGHN EDWARD PROVOST
1505 6TH AVE S
SEATTLE, WA 98134-1630
Phone number:
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