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1013152800
ELMER WALLER
KOTZEBUE, AK
NPI
1013152800
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor Addiction (Substance Use Disorder)
Enumeration Date
2008-12-08
Last Update Date
2008-12-08
Business Address
MR. ELMER WALLER
436 5TH STREET TED STEVENS WAY
KOTZEBUE, AK 99752
Phone number: 907-442-7640
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Mailing Address
MR. ELMER WALLER
436 5TH STREET TED STEVENS WAY
KOTZEBUE, AK 99752
Phone number: 907-442-7640
Copy
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