Individual
MISS PORTIA DIONNE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7800 TRAVERS RUN DR, CHARLOTTE, NC 28215-6504
(704) 506-2315
Mailing address
4450 SOUTH BLVD, SUITE 6, CHARLOTTE, NC 28209-2673
(704) 506-2315
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
11/18/2009
Last updated
11/18/2009
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