Individual
MR. ANDREW ANTHONY WALLACE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1076 SANTO ANTONIO DR, SUITE B, COLTON, CA 92324-8103
(909) 433-9824
(909) 433-9830
Mailing address
1076 SANTO ANTONIO DR, SUITE B, COLTON, CA 92324-8103
(909) 433-9824
(909) 433-9830
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
RS9874
CA
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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