MARTY DALE WALLACE

JOHNSON CITY, TN
NPI1164674743
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy367500000X Nurse Anesthetist, Certified Registered
(Licence: TN  APN13700)
Enumeration Date2008-10-15
Last Update Date2009-11-20
Business Address
-- MARTY DALE WALLACE CRNA
1114 SUNSET DR SUITE 4
JOHNSON CITY, TN 37604-2969
Phone number: 423-283-0776
Mailing Address
-- MARTY DALE WALLACE CRNA
PO BOX 3727
JOHNSON CITY, TN 37602-3727
Phone number: 423-283-0776
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