PRAVEEN ANURADHA WALALIYADDA

IDAHO FALLS, ID
NPI1710515135
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2020-03-31
Last Update Date2020-03-31
Business Address
-- PRAVEEN ANURADHA WALALIYADDA MD
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-227-2850
Mailing Address
-- PRAVEEN ANURADHA WALALIYADDA MD
3100 CHANNING WAY
IDAHO FALLS, ID 83404-7533
Phone number: 208-227-2850
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