Individual
DR. WILSON KING WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2750 INDIAN RIVER BLVD, VERO BEACH, FL 32960-5225
(772) 569-9500
(772) 569-9507
Mailing address
2750 INDIAN RIVER BLVD, VERO BEACH, FL 32960-5225
(772) 569-9500
(772) 569-9507
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME18644
FL
Other
Enumeration date
10/18/2005
Last updated
04/14/2010
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