Individual
SUSANNE R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
442 STOCKBRIDGE ROAD, GREAT BARRINGTON, MA 01230
(413) 644-0104
Mailing address
442 STOCKBRIDGE ROAD, GREAT BARRINGTON, MA 01230
(413) 644-0104
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
2083442
MA
Other
Enumeration date
03/11/2011
Last updated
03/11/2011
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