DEMETRIUS RICHARD WALLACE

VICTORVILLE, CA
NPI1073186540
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy172V00000X Community Health Worker
Enumeration Date2021-07-21
Last Update Date2021-07-21
Business Address
MR. DEMETRIUS RICHARD WALLACE
13733 ARTHUR DR
VICTORVILLE, CA 92392-0205
Phone number: 760-912-0467
Mailing Address
MR. DEMETRIUS RICHARD WALLACE
PO BOX 1477
VICTORVILLE, CA 92393-1477
Phone number:
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