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1164852422
JORGE WALLACE
SAINT LOUIS, MO
NPI
1164852422
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: MO 2011039643)
Enumeration Date
2013-11-22
Last Update Date
2016-05-26
Business Address
-- JORGE WALLACE PLPC
6532 BARTMER AVE 2E
SAINT LOUIS, MO 63130-2630
Phone number: 314-299-5284
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Mailing Address
-- JORGE WALLACE PLPC
6532 BARTMER AVE 2E
SAINT LOUIS, MO 63130-2630
Phone number: 314-299-5284
Copy
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