Organization
QUARTZ RESORT SEVERCIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLEN KNIGHT WALLACE (PRESIDENT)
(405) 728-1173
Entity
Organization
Contact information
Practice address
7932 NICHOLSON DR, OKLAHOMA CITY, OK 73162-5539
(405) 728-1173
Mailing address
7932 NICHOLSON DR, OKLAHOMA CITY, OK 73162-5539
(405) 728-1173
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
09/15/2009
Last updated
09/15/2009
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