Individual
MR. JOHN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17891 SW TUALATIN VALLEY HWY, ALOHA, OR 97006-4448
(503) 591-7027
(503) 642-9435
Mailing address
8800 SE SUNNYSIDE RD, 300, CLACKAMAS, OR 97015-5738
(503) 659-5115
Taxonomy
Speciality
Code
Description
License number
State
237700000X
Hearing Instrument Specialist
Primary
HAS-P-10135632
OR
Other
Enumeration date
07/06/2011
Last updated
07/06/2011
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