WALLACE MAXWELL GREEN

FAYETTEVILLE, GA
NPI1306979059
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy2084N0400X Psychiatry & Neurology, Neurology
(Licence: GA  001827)
Enumeration Date2007-03-13
Last Update Date2007-07-08
Business Address
Mr. WALLACE MAXWELL GREEN PAC
1275 HIGHWAY 54 W STE.105
FAYETTEVILLE, GA 30214-4549
Phone number: 770-719-2965
Mailing Address
Mr. WALLACE MAXWELL GREEN PAC
1275 HIGHWAY 54 W STE.105
FAYETTEVILLE, GA 30214-4549
Phone number: 770-719-2965
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