Graduated: 2020
NPI: 1497389456
Practice Locations (6)
1415 BRUSH OAK DR
COLORADO SPRINGS, CO 809067703
PO BOX
CHARLOTTE, NC 28289
4535 DRESSIER RD NW
CANTON, OH 447182545
9040 A JACKSON AVE
JOINT BASE LEWIS MCCHORD, WA 98431
436 BROADWAY, APT 519
TACOMA, WA 984023936
9040 JACKSON AVE
TACOMA, WA 984311100
Source: CMS National Downloadable File, September 2026.