JUSTIN DALE WALLACE

PRYOR, OK
NPI1578207072
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy175T00000X Peer Specialist
(Licence: OK  175t00000X)
Enumeration Date2022-04-21
Last Update Date2022-04-21
Business Address
JUSTIN DALE WALLACE
109 N FAIRLAND ST
PRYOR, OK 74361-4205
Phone number: 918-925-1405
Mailing Address
JUSTIN DALE WALLACE
109 N FAIRLAND ST
PRYOR, OK 74361-4205
Phone number:
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