SCOTT EARL WALLACE

ATHENS, OH
NPI1861074635
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
(Licence: OH  34.016172)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
208D00000X General Practice
(Licence: OH  34.016172)
Enumeration Date2021-04-22
Last Update Date2023-03-20
Business Address
SCOTT EARL WALLACE DO
26 HOSPITAL DR FL 2
ATHENS, OH 45701-2471
Phone number: 740-249-4122
Mailing Address
SCOTT EARL WALLACE DO
106 N ELM ST
WILLIAMSTOWN, WV 26187-1826
Phone number: 435-590-0835