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1215390109
THE WALLACE MEDICAL CONCERN
GRESHAM, OR
NPI
1215390109
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Entity Type
Organization
Authorized Contact
WILLIAM ROLLER
Operations Director
503-489-1760
Organization Subpart ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
Enumeration Date
2016-03-30
Last Update Date
2016-03-30
Business Address
THE WALLACE MEDICAL CONCERN
254 NW BURNSIDE ROAD
GRESHAM, OR 97030
Phone number: 503-489-1760
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Mailing Address
THE WALLACE MEDICAL CONCERN
254 NW BURNSIDE ROAD
GRESHAM, OR 97030
Phone number:
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