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1275906158
DUSTIN W WALLACE
BIRMINGHAM, AL
NPI
1275906158
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: AL 1-133041)
Enumeration Date
2015-11-02
Last Update Date
2015-11-02
Business Address
-- DUSTIN W WALLACE CRNP
833 PRINCETON AVE SW POB III; SUITE 200A
BIRMINGHAM, AL 35211-1323
Phone number: 205-786-2776
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Mailing Address
-- DUSTIN W WALLACE CRNP
833 PRINCETON AVE SW POB III; SUITE 200A
BIRMINGHAM, AL 35211-1323
Phone number:
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