Individual
MR. ALFRED WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4703 REVOLUTIONARY WAY, WILLIAMSBURG, VA 23188-7588
(804) 543-7493
Mailing address
4703 REVOLUTIONARY WAY, WILLIAMSBURG, VA 23188-7588
(804) 543-7493
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
03/08/2022
Last updated
03/08/2022
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