Individual
MELISSA A WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EDM
Contact information
Practice address
105 VICTORY RD, DORCHESTER, MA 02122-3518
(617) 619-6921
Mailing address
105 VICTORY RD, DORCHESTER, MA 02122-3518
(617) 619-6921
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
12/17/2007
Last updated
12/17/2007
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