Wallace Family Practice PA
NPI #1063548410 in Lehigh Acres, Florida
Provider Information
- NPI Number
- 1063548410
- Entity Type
- Organization
- Organization Name
- Wallace Family Practice PA
- Primary Specialty
- Clinic/Center
- Enumeration Date
- Feb 27, 2007
- Last Updated
- Dec 29, 2010
Practice Location
- Address
- 3400 LEE BLVD
- Address 2
- SUITE 108
- City
- Lehigh Acres
- State
- Florida
- ZIP Code
- 33971-1309
- Phone
- (239) 369-2903
Authorized Official
- Name
- TASHA B. WALLACE, D.O.
- Title
- PRESIDENT
- Phone
- (239) 369-2903
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center |
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