Individual
JOANNA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
241 WOODCOTE DR, GASTON, SC 29053-8479
(803) 397-6902
Mailing address
241 WOODCOTE DR, GASTON, SC 29053-8479
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Enumeration date
04/09/2018
Last updated
04/15/2018
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