Individual
MRS. DIANE J TRACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1446 S ARCH AVE, ALLIANCE, OH 44601-4203
(330) 823-1408
Mailing address
1446 S ARCH AVE, ALLIANCE, OH 44601-4203
(330) 823-1408
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2233363
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2233363
PROVODER
OH
Enumeration date
06/16/2008
Last updated
06/16/2008
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