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1316926066
JOHN WALLACE
NORFOLK, VA
NPI
1316926066
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date
2006-01-11
Last Update Date
2007-07-08
Business Address
-- JOHN WALLACE IDC
300 E MAIN ST SUITE 1000
NORFOLK, VA 23510-1753
Phone number: 757-628-4347
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Mailing Address
-- JOHN WALLACE IDC
235 JONATHANS WAY
SUFFOLK, VA 23434-9153
Phone number: 757-923-3793
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