Individual
AUGIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8600 W CHESTER PIKE STE 308, UPPER DARBY, PA 19082-2629
(484) 433-8208
Mailing address
4312 MAIN ST APT 316, PHILADELPHIA, PA 19127-1531
(484) 433-8208
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
28613601
PA
Other
Enumeration date
09/16/2015
Last updated
09/13/2021
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