Individual
VALERIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
833 REDDEN ROW, BLYTHEWOOD, SC 29016-7221
(910) 544-9103
Mailing address
13401 OLD MCCOLL RD, GIBSON, NC 28343-8541
(910) 544-9103
(910) 506-3532
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
007229437
SC
Other
Enumeration date
06/23/2016
Last updated
01/28/2020
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