CHARLES WALLACE NIESEN

PORT ORCHARD, WA
NPI1407048903
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225700000X Massage Therapist
(Licence: WA  MA00018507)
Enumeration Date2007-08-17
Last Update Date2007-08-17
Business Address
MR. CHARLES WALLACE NIESEN LMP
7950 STATE HIGHWAY 3 SW
PORT ORCHARD, WA 98367-9149
Phone number: 360-801-1295
Mailing Address
MR. CHARLES WALLACE NIESEN LMP
PO BOX 252
BELFAIR, WA 98528-0252
Phone number: 360-801-1295
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