Individual
MRS. JESSICA RENE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
805 N CHARLOTTE ST, DICKSON, TN 37055-1008
(615) 441-6074
Mailing address
65 RIDGE RD, APT. B-15, WAVERLY, TN 37185-2000
(931) 299-7014
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
03/01/2007
Last updated
07/08/2007
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