Organization
AMY BLAISING WALLACE, D.O. PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BLAISING WALLACE D.O. (OWNER)
(989) 723-8333
Entity
Organization
Contact information
Practice address
818 W KING ST, STE 103, OWOSSO, MI 48867-2116
(989) 723-8333
Mailing address
818 W KING ST, STE 103, OWOSSO, MI 48867-2116
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101013086
MI
Other
Enumeration date
06/13/2007
Last updated
10/09/2007
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