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Individual

JAMES WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MA, THM, STM

Contact information

Practice address
12801 FLUSHING MEADOWS DR STE 250, SAINT LOUIS, MO 63131-1829
(314) 626-4774
Mailing address
854 WEATHERWOOD DR, MANCHESTER, MO 63021-7144

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
04/30/2025
Last updated
04/30/2025
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