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1942292271
LEWIS ALFRED WALLACE
ADA, OK
NPI
1942292271
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Other Name
FRED WALLACE
Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
207R00000X Internal Medicine
(Licence: OK 3060)
Enumeration Date
2005-08-23
Last Update Date
2016-09-14
Business Address
-- LEWIS ALFRED WALLACE DO
1921 STONECIPHER BLVD
ADA, OK 74820
Phone number: 580-421-4570
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Mailing Address
-- LEWIS ALFRED WALLACE DO
1921 STONECIPHER BLVD
ADA, OK 74820
Phone number: 580-421-4570
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