Individual
IMA LATOYA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9951 ATLANTIC BLVD STE 300, JACKSONVILLE, FL 32225-6574
(833) 434-5223
(888) 686-6271
Mailing address
9951 ATLANTIC BLVD STE 300, JACKSONVILLE, FL 32225-6574
(833) 434-5223
(888) 686-6271
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
01/22/2022
Last updated
06/17/2022
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