Larry Russock
Larry Russock is an Adult Companion in Portland, Oregon. Practices as a sole proprietor. Registered with an NPI since 2010.
- In the registry since
- 2010
Practice location Address checks out
847 NE 19th AvePortland, OR 97232-2684
Phone: (503) 238-0769
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Adult Companion (primary) | Taxonomy 372600000X |
|---|
Record details
| NPI number | 1538480306 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | June 16, 2010 |
| Last updated in NPPES | June 16, 2010 |
| Mailing address | Po Box 8459, Portland, OR 97207-8459 |
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