KENNETH DANIEL FULLER

PORTLAND, OR
NPI1326665670
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225700000X Massage Therapist
(Licence: OR  12913)
Enumeration Date2020-07-02
Last Update Date2020-07-02
Business Address
KENNETH DANIEL FULLER lmt
9112 N POLK AVE
PORTLAND, OR 97203-2320
Phone number: 503-660-6154
Mailing Address
KENNETH DANIEL FULLER lmt
9112 N POLK AVE
PORTLAND, OR 97203-2320
Phone number: 503-660-6154
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