THEODORE WILLIAM WALLACE

TACOMA, WA
NPI1609931393
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: WA  PA100003556)
Enumeration Date2006-12-25
Last Update Date2007-07-08
Business Address
Mr. THEODORE WILLIAM WALLACE PA-C
MADIGAN ARMY MEDICAL CTR 9040A FITZSIMMONS DR
TACOMA, WA 98431-0001
Phone number: 253-968-5161
Mailing Address
Mr. THEODORE WILLIAM WALLACE PA-C
6317 63RD ST W
UNIVERSITY PLACE, WA 98467-4945
Phone number:
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