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Individual

MRS. SONDRA ANN WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
96 PERDUE RD, QUITMAN, GA 31643-3648
(229) 272-4376
Mailing address
96 PERDUE RD, QUITMAN, GA 31643-3648
(229) 272-4376

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5179834
FL

Other

Enumeration date
03/16/2017
Last updated
03/16/2017
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