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1154085231
MILES THOMAS WALLACE
SAN DIEGO, CA
NPI
1154085231
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-10-26
Last Update Date
2022-01-05
Business Address
MILES THOMAS WALLACE IDC
34800 BOB WILSON DR
SAN DIEGO, CA 92134-1098
Phone number: 619-532-6400
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Mailing Address
MILES THOMAS WALLACE IDC
34800 BOB WILSON DR
SAN DIEGO, CA 92134-1098
Phone number: 619-532-6400
Copy
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