Individual
BETTY RAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 PUTNAM RD, VIRGINIA BEACH, VA 23462-3146
(757) 323-9485
Mailing address
401 PUTNAM RD, VIRGINIA BEACH, VA 23462-3146
(757) 323-9485
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/15/2017
Last updated
07/21/2022
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