ELLIS J WALLACE

FORT STEWART, GA
NPI1538241815
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant Medical
(Licence: GA  002533)
Enumeration Date2006-10-19
Last Update Date2011-03-10
Business Address
ELLIS J WALLACE PA-C
1061 HARMON AVE
FORT STEWART, GA 31314-5641
Phone number: 912-435-6633
Mailing Address
ELLIS J WALLACE PA-C
1061 HARMON AVE STE 1 D03
FORT STEWART, GA 31315
Phone number: 912-435-6633
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