TERRELL RICHARD WALLACE

WARNER ROBINS, GA
NPI1356399828
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: GA  002665)
Enumeration Date2006-05-05
Last Update Date2012-09-18
Business Address
Mr. TERRELL RICHARD WALLACE PA C
136 SOUTH HOUSTON LAKE ROAD
WARNER ROBINS, GA 31088
Phone number: 478-953-1020
Mailing Address
Mr. TERRELL RICHARD WALLACE PA C
207 ESPLANADE DRIVE
WARNER ROBINS, GA 31088
Phone number: 478-922-3061
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