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1417537002
ATO WALLACE
LEXINGTON, KY
NPI
1417537002
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-04-09
Last Update Date
2021-04-09
Business Address
ATO WALLACE MD
800 ROSE ST
LEXINGTON, KY 40536-7001
Phone number: 859-232-6162
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Mailing Address
ATO WALLACE MD
800 ROSE ST
LEXINGTON, KY 40536-7001
Phone number: 859-323-6162
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