Individual
JAMES GRANT WALTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
16408 JEANIE DRIVE, AURORA, IN 45014
(513) 702-0261
Mailing address
16408 JEANIE DRIVE, AURORA, IN 45014
(513) 702-0261
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824454651
FEDERAL TAX IDENTIFICATION NUMBER
—
Enumeration date
04/02/2018
Last updated
04/02/2018
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