WALLACE FAMILY PRACTICE PA
Ambulatory Health at Lee Blvd, Lehigh Acres, FL

License number
Florida OS8622
Category
Ambulatory Health
Type
Clinic/Center
Owner
Name: TASHA B. WALLACE D.O.
Title: PRESIDENT
Phone: (239) 369-2903
Address
Address
3400 Lee Blvd SUITE 108, Lehigh Acres, FL 33971
National Provider ID: 1063548410
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Wallace Family Practice, PA

Lehigh Acres, FL

Industry:
Medical Doctor's Office
Doing business as:
Wallace Family Practice - Tasha B Wallace Do
Registration:
Sep 28, 2006
Phone:
(239) 369-2903 (Phone)
Addresses:
3400 Lee Blvd, Lehigh Acres, FL 33971
400 Lee Blvd, Lehigh Acres, FL 33936
State ID:
P06000125002
Business type:
Domestic for Profit Corporation
Director:
Tasha B. Wallace (Director)
Categories:
Family & General Practice Physicians & Surgeons, Osteopathic Physicians & Surgeons, Physicians & Surgeons

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