CAROL ANN WALLACE

CLACKAMAS, OR
NPI1639272412
Former NameCAROL ANN SMITH
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy302R00000X Health Maintenance Organization
(Licence: OR  MD14314)
Enumeration Date2006-09-06
Last Update Date2007-07-08
Business Address
CAROL ANN WALLACE MD
10180 SE SUNNYSIDE RD
CLACKAMAS, OR 97015-8970
Phone number: 503-652-2880
Mailing Address
CAROL ANN WALLACE MD
2220 NE 32ND AVE
PORTLAND, OR 97212-5108
Phone number: 503-282-6611
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