Individual
ORA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
653 63RD AVE S, ST PETERSBURG, FL 33705-5727
(727) 637-5874
Mailing address
653 63RD AVE S, ST PETERSBURG, FL 33705-5727
(727) 637-5874
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
FL
Other
Enumeration date
12/07/2024
Last updated
12/07/2024
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