Individual
MR. WALLACE L VINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
260 S SCHMIDT RD STE G, BOLINGBROOK, IL 60440-3087
(630) 754-7760
(630) 754-7761
Mailing address
260 S SCHMIDT RD STE G, BOLINGBROOK, IL 60440-3087
(630) 754-7760
(630) 754-7761
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
238000232
IL
246ZS0410X
Surgical Technologist
—
—
Other
Enumeration date
07/29/2009
Last updated
10/06/2023
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