JOHN T WALLACE

FORT BRAGG, CA
NPI1023079803
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: CA  G37773)
Enumeration Date2006-03-31
Last Update Date2011-12-22
Business Address
-- JOHN T WALLACE MD
205 SOUTH ST
FORT BRAGG, CA 95437-5540
Phone number: 707-964-1251
Mailing Address
-- JOHN T WALLACE MD
205 SOUTH ST
FORT BRAGG, CA 95437-5540
Phone number: 707-964-1251