14/05/07 22:08:02.33 8NrdFDKz0
ID:mWMT40YI0
メリケンの手下アニプレ工作員が来たなｗ
NPI Number : 1396977575
Entity Type Code : Individual
Provider Name (Legal Business Name) : YURIO MIYAZAWA
Provider Business Mailing Address
First Line : 3626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94121-2604
Country : US
Telephone Number : 415-668-5955
Fax Number :
Provider Business Practice Location Address
First Line : 3626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94121-2604
Country : US
Telephone Number : 415-668-5955
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2009
Last Update Date : 09/07/2011