Individual
BRUCE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 CRANFIELD RD, ROXIE, MS 39661-9662
(601) 660-0962
Mailing address
104 CRANFIELD RD, ROXIE, MS 39661-9662
(601) 660-0962
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
03/30/2015
Last updated
03/30/2015
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