Organization
WALLACE FAMILY PRACTICE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA B. WALLACE D.O. (PRESIDENT)
(239) 369-2903
Entity
Organization
Contact information
Practice address
3400 LEE BLVD, SUITE 108, LEHIGH ACRES, FL 33971-1309
(239) 369-2903
(239) 369-0500
Mailing address
3400 LEE BLVD, SUITE 108, LEHIGH ACRES, FL 33971-1309
(239) 369-2903
(239) 369-0500
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OS8622
FL
Other
Enumeration date
02/27/2007
Last updated
12/29/2010
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