Individual
ALVIN JOSEPH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
20 MEDICAL VILLAGE DR STE 338, EDGEWOOD, KY 41017-5414
(859) 341-2802
Mailing address
119 MARKET ST, RIPLEY, OH 45167-1125
(937) 392-1547
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
KY
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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