Individual
MRS. BRENDA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3142 HORIZON RD STE 209, ROCKWALL, TX 75032-7802
(972) 771-2018
(972) 772-4654
Mailing address
3142 HORIZON RD STE 209, ROCKWALL, TX 75032-7802
(972) 771-2018
(972) 772-4654
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA06792
TX
Other
Enumeration date
07/28/2010
Last updated
09/09/2019
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