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Individual

WALTER D STREET

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
CONTRACTOR

Contact information

Practice address
573 MOUNT HERMON CHURCH RD, BASSETT, VA 24055-3569
(276) 618-0174
Mailing address
573 MOUNT HERMON CHURCH RD, BASSETT, VA 24055-3569
(276) 618-0174

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
2701036899A
VA

Other

Enumeration date
01/29/2009
Last updated
01/29/2009
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