Individual
M WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
394 SAINT FERDINAND ST, FLORISSANT, MO 63031-5918
(314) 831-6300
Mailing address
394 SAINT FERDINAND ST, FLORISSANT, MO 63031-5918
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/30/2011
Last updated
08/22/2013
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