Individual
MR. JOEY ANDREW WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9401 BRAKEN CT, FREDERICKSBURG, VA 22408-7746
(301) 379-5971
(301) 379-5971
Mailing address
9401 BRAKEN CT, FREDERICKSBURG, VA 22408-7746
(301) 379-5971
(301) 379-5971
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B62442916
VA
Other
Enumeration date
05/26/2026
Last updated
05/26/2026
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