Individual
DAJUAWN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1333 BREWERY PARK BLVD STE 300, DETROIT, MI 48207-4544
(313) 656-0000
Mailing address
1333 BREWERY PARK BLVD STE 300, DETROIT, MI 48207-4544
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/08/2017
Last updated
12/08/2017
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