Individual
DR. KEVIN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ND
Contact information
Practice address
205 JUDITH LN, MODESTO, CA 95350-4413
(209) 809-4251
Mailing address
2842 N RICHEY BLVD, TUCSON, AZ 85716-2023
(520) 396-4866
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
707
CA
Other
Enumeration date
01/13/2015
Last updated
02/23/2021
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