Individual
MISS MICHELLE LYNN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
508 BLAIR BLVD, EUGENE, OR 97402-4630
(541) 543-0290
Mailing address
3720 STEWART RD, EUGENE, OR 97402-5405
(541) 543-0290
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12250
OR
Other
Enumeration date
12/13/2012
Last updated
12/13/2012
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