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Individual

LAUREN WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
X

Contact information

Practice address
108 GROVE ST, WORCESTER, MA 01605-2651
(508) 901-9930
Mailing address
108 GROVE ST, WORCESTER, MA 01605-2651
(508) 901-9930

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary

Other

Enumeration date
05/28/2025
Last updated
05/28/2025
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