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1174867030
ROSTISLAV V IZHEVSKIY
VANCOUVER, WA
NPI
1174867030
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
174400000X Specialist
(Licence: WA MA 60124536)
Enumeration Date
2012-11-15
Last Update Date
2012-11-15
Business Address
ROSTISLAV V IZHEVSKIY
12014 SE MILL PLAIN BLVD STE 120
VANCOUVER, WA 98684-4044
Phone number: 503-761-2110
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Mailing Address
ROSTISLAV V IZHEVSKIY
3220 NE 148TH AVE
VANCOUVER, WA 98682-8376
Phone number: 360-852-2918
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