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1124857404
JOSHUA WALLACE
MODESTO, CA
NPI
1124857404
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
175T00000X Peer Specialist
(Licence: CA MPSS-QTPCEG)
Enumeration Date
2024-07-26
Last Update Date
2024-07-26
Business Address
JOSHUA WALLACE
121 DOWNEY AVE
MODESTO, CA 95354-1208
Phone number: 209-341-1824
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Mailing Address
JOSHUA WALLACE
121 DOWNEY AVE
MODESTO, CA 95354-1208
Phone number: 209-341-1824
Copy
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