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1194220061
STEPHEN RUSSELL WALLACE
DURHAM, NC
NPI
1194220061
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2085R0202X Radiology, Diagnostic Radiology
(Licence: NC 2023-00659)
Enumeration Date
2018-03-24
Last Update Date
2023-06-27
Business Address
STEPHEN RUSSELL WALLACE DO
2301 ERWIN RD
DURHAM, NC 27705-4699
Phone number: 919-684-8111
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Mailing Address
STEPHEN RUSSELL WALLACE DO
PO BOX 63362
CHARLOTTE, NC 28263-3362
Phone number:
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