Individual
BRENDAN KIELY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 N. WOLFE STREET, MARBURG 144, BALTIMORE, MD 21287
(410) 955-2139
Mailing address
13080 MINDANAO WAY APT 91, MARINA DEL REY, CA 90292-8740
(585) 797-5627
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
02/03/2022
Last updated
02/03/2022
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