Individual
WALLACE HENRY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1055 S STAPLEY DR, MESA, AZ 85204
(480) 833-9100
Mailing address
1055 S STAPLEY DR, MESA, AZ 85204-5013
(480) 833-2641
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
AZ
Other
Enumeration date
11/23/2015
Last updated
11/23/2015
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