Individual
DR. JUSTIN K WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.V.M.
Contact information
Practice address
120 S 6TH ST, CHICKASHA, OK 73018-3420
(405) 224-8023
(405) 224-8024
Mailing address
120 S 6TH ST, CHICKASHA, OK 73018-3420
(405) 224-8023
(405) 224-8024
Taxonomy
Speciality
Code
Description
License number
State
174M00000X
Veterinarian
Primary
5380
OK
Other
Enumeration date
11/08/2013
Last updated
11/08/2013
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