Individual
LAUREL SLOUGH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
13540 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
Mailing address
13540 HULL STREET RD, MIDLOTHIAN, VA 23112-2107
(804) 739-6142
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
218358
NC
Other
Enumeration date
04/19/2016
Last updated
11/05/2021
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