BRIAN VENSON WALLACE

RIDGELAND, MS
NPI1154677359
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225100000X Physical Therapist
(Licence: MS  PT 4550)
Enumeration Date2012-07-25
Last Update Date2012-07-25
Business Address
-- BRIAN VENSON WALLACE DPT
711 AVIGNON DR
RIDGELAND, MS 39157-5120
Phone number: 601-605-6777
Mailing Address
-- BRIAN VENSON WALLACE DPT
711 AVIGNON DR
RIDGELAND, MS 39157-5120
Phone number: 601-605-6777
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