Justice Kassidy Wallace

NPI #1467173765 in Salt Lake City, Utah

Provider Information

NPI Number: 1467173765
Entity Type: Individual
Name: Justice Kassidy Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Technician
Enumeration Date: Sep 6, 2022
Last Updated: Sep 6, 2022

Practice Location

Address: 344 E 100 S STE 301
City: Salt Lake City
State: Utah
ZIP Code: 84111-1727
Phone: (801) 428-4257

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician	374700000X	Primary

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