Individual
MR. JAMES LEEMAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
29650 SW COURTSIDE DR, #14, WILSONVILLE, OR 97070-7482
(503) 682-6774
Mailing address
29650 SW COURTSIDE DR, #14, WILSONVILLE, OR 97070-7482
(503) 682-6774
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11808
OR
Other
Enumeration date
11/11/2010
Last updated
11/11/2010
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