Individual
MARISA ELLEN WUNDERLICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1002 1ST ST, CHENEY, WA 99004-1708
(509) 475-1238
Mailing address
1002 1ST ST, CHENEY, WA 99004-1708
(509) 475-1238
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00025203
WA
Other
Enumeration date
03/10/2008
Last updated
03/10/2008
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