JUSTIN CORY WALLACE

SAN DIEGO, CA
NPI1114354156
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date2013-10-06
Last Update Date2013-10-06
Business Address
-- JUSTIN CORY WALLACE Dive IDC
699 14TH ST
SAN DIEGO, CA 92101-7586
Phone number: 760-845-8116
Mailing Address
-- JUSTIN CORY WALLACE Dive IDC
699 14TH ST
SAN DIEGO, CA 92101-7586
Phone number:
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