Individual
JONATHAN ROBERT WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
12811 SE 38TH ST, BELLEVUE, WA 98006-1326
(425) 378-1800
Mailing address
2940 S FRONTENAC ST, SEATTLE, WA 98108-3790
(206) 723-1381
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00015057
WA
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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