Individual
ROMALE WALLACE SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
226 E 329TH ST, WILLOWICK, OH 44095-3225
(440) 589-0139
Mailing address
226 E 329TH ST, WILLOWICK, OH 44095-3225
(440) 589-0139
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
SS826227
OH
Other
Enumeration date
12/08/2025
Last updated
12/08/2025
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