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1952386815
CRAIGREON LEVAR WALLACE
DALLAS, TX
NPI
1952386815
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: TX PA06903)
Enumeration Date
2005-12-13
Last Update Date
2019-08-29
Business Address
CRAIGREON LEVAR WALLACE PA
6201 HARRY HINES BLVD
DALLAS, TX 75235
Phone number: 214-648-3111
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Mailing Address
CRAIGREON LEVAR WALLACE PA
PO BOX 845347
DALLAS, TX 75284-7208
Phone number:
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