Individual
CALVIN P WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17700 SE 272ND ST, COVINGTON, WA 98042-4951
(253) 372-7128
Mailing address
PO BOX 5299, TACOMA, WA 98415-0299
(253) 372-7128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00024602
WA
Other
Enumeration date
07/17/2006
Last updated
09/10/2010
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