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1437402229
BONNIE MERRITT WALLACE
PORTAGE, MI
NPI
1437402229
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363A00000X Physician Assistant
(Licence: MI 5601006513)
Enumeration Date
2012-10-18
Last Update Date
2014-10-12
Business Address
Ms. BONNIE MERRITT WALLACE PA-C
3304 COOLEY CT
PORTAGE, MI 49024-7430
Phone number: 269-349-2266
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Mailing Address
Ms. BONNIE MERRITT WALLACE PA-C
3304 COOLEY CT
PORTAGE, MI 49024-7430
Phone number: 269-349-2266
Copy
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