VINCENT WALLACE

CHICAGO, IL
NPI1144852260
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder
Enumeration Date2020-02-06
Last Update Date2020-02-06
Business Address
VINCENT WALLACE MA
226 W ONTARIO ST
CHICAGO, IL 60654-3619
Phone number: 312-912-7008
Mailing Address
VINCENT WALLACE MA
19050 MAPLE AVE
COUNTRY CLUB HILLS, IL 60478-5737
Phone number: 708-612-3784
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