Individual
MR. BURLEY WALTER BALL JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4313 BUCKINGHAM RD, COEBURN, VA 24230
(276) 395-1323
Mailing address
PO BOX 208, COEBURN, VA 24230-0208
(276) 395-1323
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
T64011149
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T64011149
—
VA
Enumeration date
09/22/2020
Last updated
09/22/2020
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