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1114044799
PAUL DAVID WALLACE
STOCKTON, CA
NPI
1114044799
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
167G00000X Licensed Psychiatric Technician
(Licence: CA PT 26296)
Enumeration Date
2007-03-26
Last Update Date
2007-07-08
Business Address
Mr. PAUL DAVID WALLACE
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-3760
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Mailing Address
Mr. PAUL DAVID WALLACE
1212 N CALIFORNIA ST
STOCKTON, CA 95202-1552
Phone number: 209-468-3760
Copy
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