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1699011908
ERNESTO ALFONSO LARA
HILLSBORO, OR
NPI
1699011908
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
225700000X Massage Therapist
(Licence: OR 17920)
Enumeration Date
2012-12-14
Last Update Date
2013-03-14
Business Address
Mr. ERNESTO ALFONSO LARA L.M.T
5405 SE ALEXANDER ST
HILLSBORO, OR 97123-8584
Phone number: 971-409-8301
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Mailing Address
Mr. ERNESTO ALFONSO LARA L.M.T
2520 SW 204TH AVE
BEAVERTON, OR 97006-1871
Phone number: 971-409-8301
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