Individual
MR. JAMES EDWARD WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
101 W UNIVERSITY AVE, SPINE AND PAIN MANAGEMENT, CHAMPAIGN, IL 61820-3909
(217) 366-8796
(217) 366-6106
Mailing address
101 W UNIVERSITY AVE, SPINE AND PAIN MANAGEMENT, CHAMPAIGN, IL 61820-3909
(217) 366-1326
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
85000087
IL
Other
Enumeration date
04/20/2007
Last updated
09/24/2013
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