JOHN GRAY WALLACE

KOSCIUSKO, MS
NPI1831486596
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207Q00000X Family Medicine
(Licence: MS  22522)
Enumeration Date2011-07-01
Last Update Date2014-09-22
Business Address
-- JOHN GRAY WALLACE M.D.
332 HIGHWAY 12 W
KOSCIUSKO, MS 39090-3209
Phone number: 662-289-1800
Mailing Address
-- JOHN GRAY WALLACE M.D.
PO BOX 23996
JACKSON, MS 39225-3996
Phone number: 601-206-6100
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