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1114140696
LISA DENISE BROADOUS
PORTLAND, OR
NPI
1114140696
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
372600000X Adult Companion
Enumeration Date
2007-04-11
Last Update Date
2007-07-08
Business Address
Mrs. LISA DENISE BROADOUS
2330 NE SISKIYOU ST
PORTLAND, OR 97212-2471
Phone number: 503-528-0757
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Mailing Address
Mrs. LISA DENISE BROADOUS
6903 N ALBINA AVE
PORTLAND, OR 97217-1603
Phone number: 503-415-1892
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