JOHN WALLACE

NORFOLK, VA
NPI1316926066
Entity TypeIndividual
GenderMale
Sole Proprietor ?
Primary Taxonomy1710I1002X Military Health Care Provider Independent Duty Corpsman
Enumeration Date2006-01-11
Last Update Date2007-07-08
Business Address
JOHN WALLACE IDC
300 E MAIN ST SUITE 1000
NORFOLK, VA 23510-1753
Phone number: 757-628-4347
Mailing Address
JOHN WALLACE IDC
235 JONATHANS WAY
SUFFOLK, VA 23434-9153
Phone number: 757-923-3793
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