Individual
MR. ANDREW WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7400 MERTON MINTER ST, SAN ANTONIO, TX 78229-4404
(210) 671-4343
Mailing address
3818 SWEET OLIVE, SAN ANTONIO, TX 78261-2825
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
700136
TX
Other
Enumeration date
06/30/2025
Last updated
06/30/2025
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