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1225388457
KEVIN WALLACE
BOSTON, MA
NPI
1225388457
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: MA S50607188)
Enumeration Date
2012-09-14
Last Update Date
2012-09-14
Business Address
Mr. KEVIN WALLACE
30 WARREN ST
BOSTON, MA 02135-3602
Phone number: 617-254-3800
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Mailing Address
Mr. KEVIN WALLACE
555 WASHINGTON ST
BRIGHTON, MA 02135-2591
Phone number:
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