JASON DAVID WALLACE

JONESBORO, AR
NPI1235755638
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: AR  125806)
Enumeration Date2020-06-22
Last Update Date2020-06-22
Business Address
Mr. JASON DAVID WALLACE
2616 GALLAWAY CV
JONESBORO, AR 72404-7827
Phone number: 615-618-6200
Mailing Address
Mr. JASON DAVID WALLACE
2616 GALLAWAY CV
JONESBORO, AR 72404-7827
Phone number: 615-618-6200
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