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1558323725
HEATH WADE WALLACE
FPO, AE
NPI
1558323725
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1710I1002X Military Health Care Provider Independent Duty Corpsman
Enumeration Date
2006-04-04
Last Update Date
2008-04-20
Business Address
MR. HEATH WADE WALLACE IDC
USS THEODORE ROOSEVELT CVN 71 MEDICAL DEPARTMENT
FPO, AE 09599 2871
Phone number: 757-445-6230
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Mailing Address
MR. HEATH WADE WALLACE IDC
1973 BIG BOULDER DR
VIRGINIA BEACH, VA 23456-6126
Phone number: 757-471-1746
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