Individual
MICHAEL WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1314 N MAIN ST, FOUNTAIN INN, SC 29644-1332
(864) 688-2018
(864) 484-8493
Mailing address
1215 NE MAIN ST STE B, SIMPSONVILLE, SC 29681-6019
(864) 688-2018
(864) 484-8493
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
IHCP-2020
SC
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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