Individual
SANDRA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIR LOSS
Contact information
Practice address
3106 MEMORIAL AVE, LYNCHBURG, VA 24501-3730
(434) 845-4448
Mailing address
3106 MEMORIAL AVE, LYNCHBURG, VA 24501-3730
(434) 845-4448
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
1201080783
VA
Other
Enumeration date
09/08/2014
Last updated
09/08/2014
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