Individual
MRS. KORE IO ELIZA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMP, MMP
Contact information
Practice address
120 THIMBLEBERRY HOLW, BURNSVILLE, NC 28714-6362
(828) 231-9523
Mailing address
120 THIMBLEBERRY HOLW, BURNSVILLE, NC 28714-6362
(828) 231-9523
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
09118
NC
Other
Enumeration date
09/16/2012
Last updated
09/16/2012
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