Individual
MARCEL ANTON ETTESVOLD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3321 W KENNEWICK AVE STE 150, KENNEWICK, WA 99336-2968
(509) 783-2085
Mailing address
3321 W KENNEWICK AVE STE 150, KENNEWICK, WA 99336-2968
(509) 735-6446
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
CG60817318
WA
Other
Enumeration date
10/31/2018
Last updated
08/29/2019
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