Individual
LEAH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1734 WICKFORD RD, CLEVELAND, OH 44112-1208
(216) 374-1546
Mailing address
1734 WICKFORD RD, CLEVELAND, OH 44112-1208
(216) 374-1546
Taxonomy
Speciality
Code
Description
License number
State
251X00000X
Supports Brokerage Agency
Primary
—
OH
Other
Enumeration date
04/04/2024
Last updated
04/06/2024
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