JOHANNA CHRISTINE PROVENZANO

PORTLAND, OR
NPI1760820914
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy372600000X Adult Companion
Enumeration Date2013-06-10
Last Update Date2013-06-10
Business Address
-- JOHANNA CHRISTINE PROVENZANO
5023 NE KILLINGSWORTH ST
PORTLAND, OR 97218-1915
Phone number: 503-284-4249
Mailing Address
-- JOHANNA CHRISTINE PROVENZANO
PO BOX 8459
PORTLAND, OR 97207-8459
Phone number: 503-238-0769
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