Individual
BRADLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6175 CAHILL AVE, STE. 103, INVER GROVE HEIGHTS, MN 55076-5501
(651) 967-7753
Mailing address
8800 SE SUNNYSIDE RD, STE. 300-N, CLACKAMAS, OR 97015-5738
(503) 659-5115
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
—
—
Other
Enumeration date
03/29/2012
Last updated
03/29/2012
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