MICHAEL ANTHONY WALLACE

PORTSMOUTH, VA
NPI1427216837
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy1710I1002X Military Health Care Provider, Independent Duty Corpsman
Enumeration Date2008-06-02
Last Update Date2011-06-23
Business Address
-- MICHAEL ANTHONY WALLACE IDC
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708-2111
Phone number: 757-953-6505
Mailing Address
-- MICHAEL ANTHONY WALLACE IDC
620 JOHN PAUL JONES CIR
PORTSMOUTH, VA 23708-2111
Phone number: 757-953-6505
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