Individual
JULIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
319 E 125TH TER, KANSAS CITY, MO 64145-1659
(816) 797-9810
Mailing address
501 E 108TH TER, KANSAS CITY, MO 64131-4019
(816) 309-0578
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
Other
Enumeration date
07/21/2025
Last updated
07/21/2025
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