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1114354156
JUSTIN CORY WALLACE
SAN DIEGO, CA
NPI
1114354156
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2013-10-06
Last Update Date
2013-10-06
Business Address
-- JUSTIN CORY WALLACE Dive IDC
699 14TH ST
SAN DIEGO, CA 92101-7586
Phone number: 760-845-8116
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Mailing Address
-- JUSTIN CORY WALLACE Dive IDC
699 14TH ST
SAN DIEGO, CA 92101-7586
Phone number:
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