KODY WALLACE

MINERAL WELLS, TX
NPI1912061607
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy225100000X Physical Therapist
(Licence: TX  1141471)
Enumeration Date2006-12-20
Last Update Date2007-07-08
Business Address
-- KODY WALLACE
400 SW 25TH AVE
MINERAL WELLS, TX 76067-8246
Phone number: 940-328-6580
Mailing Address
-- KODY WALLACE
705 N MURCO DR
MINERAL WELLS, TX 76067-9008
Phone number:
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