MR. James Edward Wallace JR., PA-C

NPI #1053539783 in Champaign, Illinois

Provider Information

NPI Number
1053539783
Entity Type
Individual
Name
MR. James Edward Wallace JR., PA-C
Gender
Not Specified
Sole Proprietor
No
Primary Specialty
Physician Assistant
Credential
PA-C
Enumeration Date
Apr 20, 2007
Last Updated
Sep 24, 2013

Practice Location

Address
101 W UNIVERSITY AVE
Address 2
SPINE AND PAIN MANAGEMENT
ZIP Code
61820-3909
Phone
(217) 366-8796

Specialties & Taxonomy Codes

Specialty
Physician Assistant

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