Individual
KILAR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
34800 BOB WILSON DR, SAN DIEGO, CA 92134-1098
(570) 665-1814
Mailing address
5550 SURF RIDER WAY APT 133, SAN DIEGO, CA 92154-6528
(570) 665-1814
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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