BRIAN LESLIE WALLACE

ELIZABETH CITY, NC
NPI1790888501
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy225100000X Physical Therapist
(Licence: NC  10128)
Enumeration Date2006-09-07
Last Update Date2007-07-08
Business Address
Mr. BRIAN LESLIE WALLACE MS PT
901 HALSTEAD BLVD
ELIZABETH CITY, NC 27909-6920
Phone number: 252-338-0137
Mailing Address
Mr. BRIAN LESLIE WALLACE MS PT
1105 W CHURCH ST
ELIZABETH CITY, NC 27909-4609
Phone number: 252-338-5948
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