Individual
MRS. AJA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
215 MAPLE DR, LAKE CITY, SC 29560-3931
(843) 939-1363
Mailing address
215 MAPLE DR, LAKE CITY, SC 29560-3931
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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