KENT WILLIAM WALLACE

EVERETT, WA
NPI1770662835
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AS0400X Physician Assistant, Surgical
(Licence: WA  PA10000442)
Enumeration Date2006-11-02
Last Update Date2015-02-06
Business Address
-- KENT WILLIAM WALLACE PA-C, ARNP
1321 COLBY AVE MEDICAL STAFF OFFICE (PMG)
EVERETT, WA 98201-1665
Phone number: 425-261-2000
Mailing Address
-- KENT WILLIAM WALLACE PA-C, ARNP
PO BOX 3360 PROVIDENCE HEALTH & SERVICES
PORTLAND, OR 97208-3360
Phone number: 866-366-2983
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