Individual
ALISA D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
803 COLUMBIA AVE, MONTICELLO, KY 42633
(606) 348-9318
Mailing address
130 SOUTHERN SCHOOL RD, SOMERSET, KY 42501-3223
(606) 679-4782
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/24/2019
Last updated
01/24/2019
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