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1457561615
BRIAN WALLACE
TYLER, TX
NPI
1457561615
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363LP2300X Nurse Practitioner, Primary Care
(Licence: CO RN 169685c)
Enumeration Date
2007-05-23
Last Update Date
2010-03-12
Business Address
-- BRIAN WALLACE N.P.
1910 ROSELAND BLVD
TYLER, TX 75701-4246
Phone number: 903-533-0644
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Mailing Address
-- BRIAN WALLACE N.P.
1910 ROSELAND BLVD
TYLER, TX 75701-4246
Phone number: 903-533-0644
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