JUSTIN COVEY WALLACE

PHOENIX, AZ
NPI1578807103
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy163WE0003X Registered Nurse, Emergency
(Licence: AZ  RN173423)
Enumeration Date2012-11-20
Last Update Date2012-11-20
Business Address
-- JUSTIN COVEY WALLACE RN
4212 N 16TH ST
PHOENIX, AZ 85016-5319
Phone number: 602-263-1200
Mailing Address
-- JUSTIN COVEY WALLACE RN
13126 N 154TH AVE
SURPRISE, AZ 85379-9150
Phone number:
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