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1730128372
KEVIN L WALLACE
PHOENIX, AZ
NPI
1730128372
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
2083T0002X Preventive Medicine, Medical Toxicology
(Licence: AZ 23348)
Enumeration Date
2006-06-06
Last Update Date
2007-07-08
Business Address
-- KEVIN L WALLACE MD
925 E MCDOWELL RD
PHOENIX, AZ 85006-2502
Phone number: 602-239-2371
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Mailing Address
-- KEVIN L WALLACE MD
72 BRENTWOOD RD
CAPE ELIZABETH, ME 04107-2227
Phone number: 602-769-1301
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