Individual
BODI GRAYSON WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5408 MORNING GLORY ST, SOUTH BLOOMFIELD, OH 43103-3518
(740) 497-6108
Mailing address
5408 MORNING GLORY ST, SOUTH BLOOMFIELD, OH 43103-3518
(740) 497-6108
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
05/11/2024
Last updated
05/11/2024
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