Individual
CORENNA LOUISE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4411 E KINGS CANYON RD, BLDG 319, FRESNO, CA 93702-3604
(559) 453-6227
(559) 452-8901
Mailing address
4411 E KINGS CANYON RD, BLDG 319, FRESNO, CA 93702-3604
(559) 453-6227
(559) 452-8901
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/28/2010
Last updated
12/28/2010
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