LEWIS ALFRED WALLACE

ADA, OK
NPI1942292271
Other NameFRED WALLACE
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207R00000X Internal Medicine
(Licence: OK  3060)
Enumeration Date2005-08-23
Last Update Date2016-09-14
Business Address
LEWIS ALFRED WALLACE DO
1921 STONECIPHER BLVD
ADA, OK 74820
Phone number: 580-421-4570
Mailing Address
LEWIS ALFRED WALLACE DO
1921 STONECIPHER BLVD
ADA, OK 74820
Phone number: 580-421-4570
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